Urgent transjugular retrograde obliteration for prophylaxis of rebleeding from gastric varices in patients with a spontaneous portosplenorenal shunt

Background: Bleeding isolated gastric varices with a spontaneous portosplen orenal shunt are difficult to control. The urgent use of transjugular retro grade obliteration (TJO) to prevent early rebleeding and to improve early m ortality has not yet been demonstrated. We report our experience with this technique in patients with isolated gastric va rices after treatment of acu te bleeding. Methods: We reviewed our experience of 6 patients with isolate d gastric varices with a spontaneous portosplenoral shunt treated with TJO after treatment of acute bleeding. We basically applied endoscopic glue emb olization using cyanoacrylate monomer for treatment of acute bleeding. TJO was a method using an occlusive balloon catheter to control a spontaneous p ortosplenorenal shunt flow while injecting sclerosant retrograde into the g astric va rices. Results: Treatment of acute bleeding was achieved immediat ely by endoscopic glue embolization, endoscopic variceal ligation, and liga ting the varices with sutures following anterior gastrotomy in 4, 1 and 1 p atients, respectively, and then TJO was performed. Permanent hemostasis and variceal eradication was achieved in these 6, and they all survived. They were alive for 6-66 months without gastric variceal recurrence. Conclusions : We conclude that urgent TJO is effective in the prophylaxis of early and late rebleeding from isolated gastric varices in patients with a spontaneou s portosplenorenal shunt. Copyright (C) 2000 S. Karger AG, Basel.