Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases
Backgroud/rationale of study. Analyze safety and efficacy of angiographic-occlusion-with-sclerotherapy/ embolotherapy-without-transjugular-intrahepatic-portosystemic-shunt (TIPS) for duodenal varices. Although TIPS is considered the best intermediate-to-long term therapy after failed endoscopic ther...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2015-05-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268119312773 |
| _version_ | 1818608177420173312 |
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| author | Alexander Copelan Monzer Chehab Purushottam Dixit Mitchell S. Cappell |
| author_facet | Alexander Copelan Monzer Chehab Purushottam Dixit Mitchell S. Cappell |
| author_sort | Alexander Copelan |
| collection | DOAJ |
| description | Backgroud/rationale of study. Analyze safety and efficacy of angiographic-occlusion-with-sclerotherapy/ embolotherapy-without-transjugular-intrahepatic-portosystemic-shunt (TIPS) for duodenal varices. Although TIPS is considered the best intermediate-to-long term therapy after failed endoscopic therapy for bleeding varices, the options are not well-defined when TIPS is relatively contraindicated, with scant data on alternative therapies due to relative rarity of duodenal varices. Prior cases were identified by computerized literature search, supplemented by one illustrative case. Favorable clinical outcome after angiography defined as no rebleeding during follow-up, without major procedural complications.Results. Thirty-two cases of duodenal varices treated by angiographic-occlusion-with-sclerotherapy/embolotherapy-without-TIPS were analyzed. Patients averaged 59.5 ± 12.2 years old (female = 59%). Patients presented with melena-16, hematemesis & melena-5, large varices-5, growing varices-2, ruptured varices-1, and other3. Twenty-nine patients had cirrhosis; etiologies included: alcoholism-11, hepatitis C-11, primary biliary cirrhosis-3, hepatitis B-2, Budd-Chiari-1, and idiopathic-1. Three patients did not have cirrhosis, including hepatic metastases from rectal cancer-1, Wilson’s disease-1, and chronic liver dysfunction-1. Thirty-one patients underwent esophagogastroduodenoscopy before therapeutic angiography, including fifteen undergoing endoscopic variceal therapy. Therapeutic angiographic techniques included balloon-occludedretrograde-transvenous-obliteration (BRTO) with sclerotherapy and/or embolization-21, DBOE (double-balloon-occluded-embolotherapy)-5, and other-6. Twenty-eight patients (87.5%; 95%-confidence interval: 69-100%) had favorable clinical outcomes after therapeutic angiography. Three patients were therapeutic failures: rebleeding at 0, 5, or 10 days after therapy. One major complication (Enterobacter sepsis) and one minor complication occurred.Conclusions. This work suggests that angiographic-occlusion-with-sclerotherapy/embolotherapy-without-TIPS is relatively effective (-90% hemostasis-rate), and relatively safe (3% major-complication-rate). This therapy may be a useful treatment option for duodenal varices when endoscopic therapy fails and TIPS is relatively contraindicated. |
| first_indexed | 2024-12-16T14:38:30Z |
| format | Article |
| id | doaj.art-8c87f632134e427490dfee96e70a4a72 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-16T14:38:30Z |
| publishDate | 2015-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-8c87f632134e427490dfee96e70a4a722022-12-21T22:28:02ZengElsevierAnnals of Hepatology1665-26812015-05-01143369379Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 casesAlexander Copelan0Monzer Chehab1Purushottam Dixit2Mitchell S. Cappell3Department of Radiology, William Beaumont Hospital, Royal Oak, MI, USADepartment of Radiology, William Beaumont Hospital, Royal Oak, MI, USADepartment of Radiology, William Beaumont Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Royal Oak, MI, USAOakland University William Beaumont School of Medicine, Royal Oak, MI, USA; Division of Gastroenterology & Hepatology, William Beaumont Hospital, Royal Oak, MI, USA; Correspondence and reprint request:Backgroud/rationale of study. Analyze safety and efficacy of angiographic-occlusion-with-sclerotherapy/ embolotherapy-without-transjugular-intrahepatic-portosystemic-shunt (TIPS) for duodenal varices. Although TIPS is considered the best intermediate-to-long term therapy after failed endoscopic therapy for bleeding varices, the options are not well-defined when TIPS is relatively contraindicated, with scant data on alternative therapies due to relative rarity of duodenal varices. Prior cases were identified by computerized literature search, supplemented by one illustrative case. Favorable clinical outcome after angiography defined as no rebleeding during follow-up, without major procedural complications.Results. Thirty-two cases of duodenal varices treated by angiographic-occlusion-with-sclerotherapy/embolotherapy-without-TIPS were analyzed. Patients averaged 59.5 ± 12.2 years old (female = 59%). Patients presented with melena-16, hematemesis & melena-5, large varices-5, growing varices-2, ruptured varices-1, and other3. Twenty-nine patients had cirrhosis; etiologies included: alcoholism-11, hepatitis C-11, primary biliary cirrhosis-3, hepatitis B-2, Budd-Chiari-1, and idiopathic-1. Three patients did not have cirrhosis, including hepatic metastases from rectal cancer-1, Wilson’s disease-1, and chronic liver dysfunction-1. Thirty-one patients underwent esophagogastroduodenoscopy before therapeutic angiography, including fifteen undergoing endoscopic variceal therapy. Therapeutic angiographic techniques included balloon-occludedretrograde-transvenous-obliteration (BRTO) with sclerotherapy and/or embolization-21, DBOE (double-balloon-occluded-embolotherapy)-5, and other-6. Twenty-eight patients (87.5%; 95%-confidence interval: 69-100%) had favorable clinical outcomes after therapeutic angiography. Three patients were therapeutic failures: rebleeding at 0, 5, or 10 days after therapy. One major complication (Enterobacter sepsis) and one minor complication occurred.Conclusions. This work suggests that angiographic-occlusion-with-sclerotherapy/embolotherapy-without-TIPS is relatively effective (-90% hemostasis-rate), and relatively safe (3% major-complication-rate). This therapy may be a useful treatment option for duodenal varices when endoscopic therapy fails and TIPS is relatively contraindicated.http://www.sciencedirect.com/science/article/pii/S1665268119312773Portal hypertensionCirrhosisEndoscopic hemostasisCoil embolizationTransjugular intrahepatic portosystemic shunt (TIPS)Balloon-occluded retrograde transvenous obliteration (BRTO) |
| spellingShingle | Alexander Copelan Monzer Chehab Purushottam Dixit Mitchell S. Cappell Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases Annals of Hepatology Portal hypertension Cirrhosis Endoscopic hemostasis Coil embolization Transjugular intrahepatic portosystemic shunt (TIPS) Balloon-occluded retrograde transvenous obliteration (BRTO) |
| title | Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases |
| title_full | Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases |
| title_fullStr | Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases |
| title_full_unstemmed | Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases |
| title_short | Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases |
| title_sort | safety and efficacy of angiographic occlusion of duodenal varices as an alternative to tips review of 32 cases |
| topic | Portal hypertension Cirrhosis Endoscopic hemostasis Coil embolization Transjugular intrahepatic portosystemic shunt (TIPS) Balloon-occluded retrograde transvenous obliteration (BRTO) |
| url | http://www.sciencedirect.com/science/article/pii/S1665268119312773 |
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