Bleeding Gastric Varices Obliteration with Balloon-occluded Retrograde Transvenous Obliteration Using Sodium Tetradecyl Sulfate Foam

Abstract 

Purpose

Balloon-occluded retrograde transvenous obliteration (BRTO) of bleeding gastric varices (GV) is well described in the literature. Using Ethanolamine oleate as the sclerosing agent in BRTO, but it is not readily available in the United States in the desired concentrations. The authors' aim is to describe their initial experience with BRTO using sodium tetradecyl sulfate (STS) foam as an alternative sclerosing agent.

Materials and Methods

The authors performed a retrospective review of their initial series in which STS foam was used to treat bleeding GV using BRTO. All study subjects had endoscopic evidence of gastric variceal bleeding. STS foam was made using a combination of agents with a 3:2:1 ratio of gas: 3% STS: Lipiodol (Ethiodol; Savage Laboratories, Melville, New York). Mean values and ranges were calculated for each variable, and clinical and imaging outcomes were assessed.

Results

The authors performed BRTO in 22 cirrhotic patients (11 men and 11 women) with a mean age of 52 years (range, 23–83 years). Technical success was achieved in 20 of 22 (91%) patients. Complications occurred in three of 22 (14%) patients. The overall mean dose of STS used was 300 mg (range, 30–600 mg) with mean total volume of sclerosant mixture of 34.1 mL (range, 10–65 mL). Follow-up imaging was available for 18 of 20 (90%) technically successful procedures with a mean period of 89 days (range, 1–359 days). Complete obliteration of GV was achieved in 16 of 18 (89%) patients. There were no cases of recurrent variceal bleeding with a mean clinical follow-up period of 130 days (range, 1–510).

Conclusions

BRTO utilizing STS foam appears effective in obliterating bleeding GVs with good short-term outcomes.

Abbreviations: BRTO, balloon-occluded retrograde transvenous obliteration, EBC, endoscopic N-butyl-2-cyanoacrylate, EO, ethanolamine oleate, EUS, endoscopic ultrasound, GRS, gastrorenal shunt, GV, gastric varices, STS, sodium tetradecyl sulfate, TIPS, transjugular intrahepatic portosystemic shunts