Digestive Diseases and Sciences

, Volume 56, Issue 8, pp 2466–2472

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

  • John P. Rice
  • Meghan Lubner
  • Andrew Taylor
  • Bret J. Spier
  • Adnan Said
  • Michael R. Lucey
  • Alexandru Musat
  • Mark Reichelderfer
  • Patrick R. Pfau
  • Deepak V. Gopal
Original Article

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.

Keywords

Gastric varices N-butyl-cyanoacrylate tissue adhesive Multi-detector (MD) CT-portography Therapeutic endoscopy Gastric variceal volume calculations 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • John P. Rice
    • 1
  • Meghan Lubner
    • 2
  • Andrew Taylor
    • 3
  • Bret J. Spier
    • 1
  • Adnan Said
    • 1
  • Michael R. Lucey
    • 1
  • Alexandru Musat
    • 1
  • Mark Reichelderfer
    • 1
  • Patrick R. Pfau
    • 1
  • Deepak V. Gopal
    • 4
  1. 1.Division of Gastroenterology and HepatologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of RadiologyVirginia Commonwealth University School of MedicineRichmondUSA
  4. 4.Division of Gastroenterology & HepatologyUniversity of Wisconsin School of Medicine & Public HealthMadisonUSA

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