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Coexistence of “extra-gastric afferent–efferent direct connection” with gastric varices: CT evaluation and clinical significance

  • Interventional Radiology
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the prevalence of extra-gastric direct connection between afferent and efferent veins of gastric varices (GVs) (i.e., EAEDC) and its clinical significance during balloon-occluded retrograde transvenous obliteration (BRTO).

Materials and methods

57 patients who underwent BRTO for GVs obliteration were retrospectively enrolled in this study. Pre-procedural CT images were reviewed for the presence of EAEDC. Patients were categorized into group A (patients with EAEDC) and group B (Patients with no detectable EAEDC). Intraprocedural images were reviewed to see if EAEDCs could be seen and if additional techniques were used to preserve or occlude them. Post-procedural CT images were reviewed for GVs obliteration, portal/splenic vein thrombosis, EAEDC patency, and ascites exacerbation. Post-procedural esophageal varices aggravation was evaluated by upper endoscopy.

Results

39 EAEDCs were identified in CT images of 35 patients (i.e., group A = 61.4%). Among them, only 20 EAEDCs were visualized during BRTO. In the remaining 22 patients, EAEDC was not identified in CT images or during BRTO (i.e., group B = 38.6%). There was no statistically significant difference between group A and B regarding post-BRTO GVs obliteration and portal/splenic vein thrombosis. Use of additional techniques to preserve EAEDC patency had significantly reduced the incidence of ascites and esophageal varices exacerbation (p = 0.036 and 0.028, respectively). In patients with EAEDC diameter ≥ 5 mm, EAEDC preservation or obliteration by coils or balloon had significantly reduced the injected sclerosant volume (p = 0.003).

Conclusion

CT is very useful for EAEDC detection. EAEDC preservation may decrease the incidence of post-BRTO ascites and esophageal varices exacerbation.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Assuit University, Assuit, 71515, Egypt

    Ramy Ahmed

  2. Department of Radiology, Faculty of Medicine, Oita University, Oita, Japan

    Ramy Ahmed, Hiro Kiyosue, Miyuki Maruno, Shunro Matsumoto & Hiromu Mori

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  1. Ramy Ahmed
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  2. Hiro Kiyosue
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  3. Miyuki Maruno
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  4. Shunro Matsumoto
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  5. Hiromu Mori
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Correspondence to Ramy Ahmed.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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This retrospective study was approved by our institutional review board, and the requirement to obtain written informed consent was waived.

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Ahmed, R., Kiyosue, H., Maruno, M. et al. Coexistence of “extra-gastric afferent–efferent direct connection” with gastric varices: CT evaluation and clinical significance. Abdom Radiol 44, 2699–2707 (2019). https://doi.org/10.1007/s00261-019-02033-z

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