Evaluation of Treatment Response after Endoscopic Variceal Obturation with Abdominal Computed Tomography

Han Ah Lee, Hyun Gil Goh, Tae Hyung Kim, Young Sun Lee, Sang Jun Suh, Young Kul Jung, Hyuk Soon Choi, Eun Sun Kim, Ji Hoon Kim, Hyunggin An, Yeon Seok Seo, Hyung Joon Yim, Sung Bum Cho, Yoon Tae Jeen, Jong Eun Yeon, Hoon Jai Chun, Kwan Soo Byun, Soon Ho Um, Chang Duck Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Backgrounds/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions: Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.

Original languageEnglish
Pages (from-to)117-124
Number of pages8
JournalGut and liver
Volume14
Issue number1
DOIs
Publication statusPublished - 2020 Jan 15

Keywords

  • Cyanoacrylates
  • Esophageal and gastric varices
  • Ethiodized oil
  • Tomography
  • X-ray computed

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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