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CT Portography with Gastric Variceal Volume Measurements in the Evaluation of Endoscopic Therapeutic Efficacy of Tissue Adhesive Injection into Gastric Varices: A Pilot Study

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Abstract

Background

N-butyl-2-cyanoacrylate (NBCA) injection is used for treating gastric varices (GV). Determining the degree of obliteration of GV is not readily evident at endoscopy.

Aims

The aim of this study was to evaluate CT portography with gastric variceal volume calculations to assess endoscopic therapeutic efficacy of NBCA injection.

Methods

The study design is a retrospective series pilot study. The setting is a single, tertiary care academic medical center. Ten patients underwent esophagogastroduodenoscopy (EGD) with NBCA injection of GV and had biphasic CT scans performed before and after injection therapy. Based on portal venous images, 3D reconstruction and semi-automated volume calculations of GV were performed. Pre and post injection GV volume calculations were compared.

Results

The mean pre-procedure GV volume was 89.84 cm3. Eight patients had significant improvement in GV volume from pre-treatment versus post-treatment (95.65 cm3 vs. 49.65 cm3, P-value 0.04). Pre-procedure GV volume was not significantly different in patients treated for active hemorrhage versus no hemorrhage (101.66 cm3 vs. 72.11 cm3, P-value 0.33). Two patients had a subsequent GV hemorrhage after NBCA injection. The mean residual GV volume in these patients versus those that did not re-bleed was significantly more (127.77 cm3 vs. 38.00 cm3, P-value 0.005).

Conclusions

CT portography with measurement of GV volume is a potentially useful tool in determining the therapeutic efficacy NBCA injection of GV. Patients with higher residual GV volumes are at increased risk of hemorrhage and may benefit from repeat injection to reach ideal GV volumes.

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Acknowledgments

We, the authors, would like to thank Stephanie Barnnett, from the Department of Abdominal Imaging and Radiology, University of Wisconsin—School of Medicine & Public Health, Madison, WI, USA for her technical assistance in obtaining accurate gastric variceal volume calculations.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, H6/516 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-5124, USA

    John P. Rice, Bret J. Spier, Adnan Said, Michael R. Lucey, Alexandru Musat, Mark Reichelderfer & Patrick R. Pfau

  2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Meghan Lubner

  3. Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Andrew Taylor

  4. Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine & Public Health, Room # 4229 UWMF Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA

    Deepak V. Gopal

Authors
  1. John P. Rice
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  2. Meghan Lubner
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  3. Andrew Taylor
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  4. Bret J. Spier
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  5. Adnan Said
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  6. Michael R. Lucey
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  7. Alexandru Musat
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  8. Mark Reichelderfer
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  9. Patrick R. Pfau
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  10. Deepak V. Gopal
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Corresponding author

Correspondence to Deepak V. Gopal.

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Rice, J.P., Lubner, M., Taylor, A. et al. CT Portography with Gastric Variceal Volume Measurements in the Evaluation of Endoscopic Therapeutic Efficacy of Tissue Adhesive Injection into Gastric Varices: A Pilot Study. Dig Dis Sci 56, 2466–2472 (2011). https://doi.org/10.1007/s10620-011-1616-z

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  • DOI: https://doi.org/10.1007/s10620-011-1616-z

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