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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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.
The aim of this study was to evaluate CT portography with gastric variceal volume calculations to assess endoscopic therapeutic efficacy of NBCA injection.
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.
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).
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.
- Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16:1343–1349. CrossRef
- Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc. 1986;32:264–268. CrossRef
- Lee MS, Cho JY, Cheon YK, et al. Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices. Gastrointest Endosc. 2002;56:83–88. CrossRef
- Sarin SK. Long-term followup of gastric variceal sclerotherapy: An eleven-year experience. Gastrointest Endosc. 1997;46:8–14. CrossRef
- Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97:110–1015. CrossRef
- Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varies. Hepatology. 2001;33:1060–1064. CrossRef
- Procaccini NJ, Al-Osaimi AMS, Northup P, Argo C, Caldwell SH. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: A single-center US analysis. Gastrointest Endosc. 2009;70:881–887. CrossRef
- Chang YJ, Park JJ, Joo MK, et al. Long term outcomes of prophylactic histoacryl injection for gastric varices with a high risk of bleeding. Dig Dis Sci. 2009;55:2391–2397.
- See A, Florent C, Lamy P, Levy VG, Bouvry M. Cerebrovascular accidents after endoscopic obturation of esophageal varices with isobutyl-2-cyanoacrylate in 2 patients. Gastroenterol Clin Biol. 1986;10:604–607.
- Roesch W, Rexroth G. Pulmonary, cerebral, and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy. 1998;30:S89–S90.
- Lee YT, Chan FK, Ng EK, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc. 2000;52:168–174. CrossRef
- Iwase H, Suga S, Morise K, Kuroiwa A, Yamaguchi T, Horiuchi Y. Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and endoscopic obliteration with cyanoacrylate glue. Gastrointest Endosc. 1995;41:150–154. CrossRef
- Battaglia G, Bocus P, Morbin T, Ancona E. Endoscopic Doppler US-guided injection therapy for gastric varices: case report. Gastrointest Endosc. 2003;57:608–611. CrossRef
- Romero-Castro R, Pellicer-Bautista FJ, Jiminez-Saenz M, et al. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc. 2007;66:402–407. CrossRef
- Zhao LQ, He W, Ji M, Liu P, Li P. 64-row multidetector computed tomography portal venography of gastric variceal collateral circulation. World J Gastroenterol. 2010;16:1003–1007. CrossRef
- Spier BJ, Taylor AJ, Pfau PR, Said A, Gopal DV. A non-invasive imaging technique to evaluate therapeutic efficacy of n-butyl-2-cyanoacrylate tissue adhesive into gastric varices: a case report. Can J Gastroenterol. 2009;23:412–414.
- Chen T, Yang Z, Li X, Wang Q, Quian L, Wang R. Evaluation of entire gastric fundic and esophageal varices secondary to posthepatitic cirrhosis: portal venography using 64-row MDCT. Abdom Imaging. 2010;35:1–7. CrossRef
- Chen YY, Shen TC, Soon MS, Lai JH. Life-threatening pericarditis after N-2-butyl-cyanoacrylate injection for esophageal variceal bleeding: case report. Gastrointest Endosc. 2005;61:487–489. CrossRef
- Zhu H, Shi B, Upadhyaya M, et al. Thereapeutic endoscopy of localized gastric varices: Pretherapy screening and posttreatment evaluation with MDCT portography. Abdom Imaging. 2010;35:15–22. CrossRef
- Kim T, Shijo H, Kokawa H, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25:307–312. CrossRef
- Hashizume M, Kitano S, Yamaga H, et al. Endoscopic classification of gastric varices. Gastrointest Endosc. 1990;36:276–280. CrossRef
- Mahl TC, Groszmann RJ. Pathophysiology of portal hypertension and variceal bleeding. Surg Clin North Am. 1990;70:251–266.
- CT Portography with Gastric Variceal Volume Measurements in the Evaluation of Endoscopic Therapeutic Efficacy of Tissue Adhesive Injection into Gastric Varices: A Pilot Study
Digestive Diseases and Sciences
Volume 56, Issue 8 , pp 2466-2472
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Gastric varices
- N-butyl-cyanoacrylate tissue adhesive
- Multi-detector (MD) CT-portography
- Therapeutic endoscopy
- Gastric variceal volume calculations
- Industry Sectors
- Author 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
- 2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- 3. Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- 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