Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts

Background and objectives. There is no standard treatment for gastric varic es. Transjugular retrograde obliteration (TJO) is one way of obliterating g astric varices with gastrorenal shunts, in which blood flow is abundant. Ou r aim was to examine our experience with TJO during an 8-year period and to determine the long-term effects of this treatment. Methods. We performed TJO procedures in 52 patients to obliterate gastric v arices. All the patients had liver cirrhosis. Sixteen had hepatocellular ca rcinoma (HCC) without vascular invasion. We inserted an angiographic cathet er with an occlusive balloon through the right internal jugular vein into t he gastrorenal shunt or the gastric varices. After controlling the other bl ood-draining routes with a microcoil or absolute ethanol, or both, we injec ted 5% ethanolamine oleate with iopamidol into the gastric varices under fl uoroscopy. Results. The gastric varices were successfully obliterated by TJO in all ca ses. The complications were all minor and transient. The mortality rate for TJO was 0%. There was not recurrence and no bleeding of gastric varices at all after TJO. Patient survival differed depending on the presence or abse nce of HCC gastric varices at all after TJO. Patient survival differed depe nding on the presence or absence of HCC (P < .05). The development of HCC i n the cirrhotic liver was the most common cause of late death. Gastrointest inal bleeding was not a cause of death. The occurrence rate of esophageal v arices after TJO was high, but these varices could be treated easily by end oscopic injection sclerotherapy before they bled. Conclusions. Portal blood flow through the gastrorenal shunt is diverted to the porto-azygos venous system after the gastrorenal shunt is obliterated by TJO. TJO is a safe option that we recommend for treating gastric varices with gastrorenal shunts, provided that the TJO is followed by endoscopic i njection sclerotherapy.