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ABSTRACT: : The purpose of this study was to investigate the effects of combined therapy using partial splenic embolization (PSE) and transjugular retrograde obliteration (TJO) on the systemic hemodynamics of gastric varices with a splenorenal shunt.
: Eleven patients having gastric varices with a splenorenal shunt were included in this study. PSE was applied 2 weeks before TJO. Systemic hemodynamic studies were performed before and 22±12 months after the combined therapy.
: Complete obliteration of the splenorenal shunt and gastric varices was revealed by retrograde shuntography and computed tomography after TJO in all cases. The cardiac index (1/min/m) before and after the combined therapy was 3.98±0.85 and 4.05±0.78, respectively. The systemic vascular resistance index (dynes s/cm/m) before and after the combined therapy was 1887±450 and 1837±4621, respectively. They showed no significant change. The arterio-venous oxygen content difference (vol%) before and after the combined therapy was 2.55±0.55 and 3.21±0.90, respectively, showing a significant change (P<0.05). The splenic venous flow volume before and after the combined therapy was 307±158 and 166±78 mL/min, respectively, showing a significant change (P<0.05).
: We conclude that the combined therapy using PSE and TJO reduces the splenic venous flow and stops the splenorenal shunt flow, which improves the arterio-venous oxygen content difference.
Surgical laparoscopy, endoscopy & percutaneous techniques 04/2013; 23(2):149-53. · 1.23 Impact Factor
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ABSTRACT: The case was a 76-year-old female, who was noted to have a gastric submucosal tumor 25 mm in size located at the lesser curvature of the gastric body. Computed tomography revealed that the tumor was located near the coronary loop between the left and right gastric arteries. On the day before endoscopic local resection, abdominal angiography was performed and it revealed that the tumor was supplied by the left and right gastric arteries. Superselective transarterial embolization of the left and right gastric arteries around the tumor was performed to prevent accidental bleeding during the endoscopic procedure. Endoscopic local resection using full-thickness resection and submucosal dissection techniques was performed under general anesthesia. The tumor was completely resected without accidental bleeding. A gastric wall defect was closed using metallic clips and loop snares. Histologic examination revealed that the tumor was a low-risk gastrointestinal stromal tumor. We suggest that the combined therapy using superselective transarterial embolization and endoscopic local resection is an optional safe method for the treatment of gastric submucosal tumors.
Surgical laparoscopy, endoscopy & percutaneous techniques 10/2012; 22(5):e297-300. · 1.23 Impact Factor
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ABSTRACT: The purpose of the present study was to investigate the short-term effects of combined therapy using partial splenic embolization (PSE) and transjugular retrograde obliteration (TJO) on the portal hemodynamics of gastric varices with a gastrorenal shunt.
Sixteen patients with gastric varices and a gastrorenal shunt were included in this study. Partial splenic embolization was applied 2 weeks before TJO. The portal blood flow was measured by an ultrasonic duplex Doppler system, and the wedged hepatic venous pressure (WHVP) was measured by hepatic venous catheterization, before and after the combined therapy.
The complete obliteration of the gastrorenal shunt and gastric varices was revealed by retrograde shuntography and computed tomography after TJO in all cases. The WHVP before and just after PSE was 23 +/- 7 and 19 +/- 7 mmHg, respectively, showing a significant change (P < 0.01). The WHVP before and the day after TJO was 20 +/- 5 mmHg and 22 +/- 6 mmHg, respectively, showing a significant change (P < 0.01). There was no significant difference between the WHVP before and after the combined therapy. The portal venous flow volume before and after the combined therapy were 514 +/- 146 and 512 +/- 161 ml/min, respectively, showing no significant change. However, the splenic venous flow volume before and after the combined therapy was 319 +/- 131 and 179 +/- 113 ml/min, respectively, showing a significant change (P < 0.05).
The WHVP did not change after the combined therapy of PSE and TJO. Partial splenic embolization contributed to protecting portal congestion after TJO. We conclude that the combined therapy using PSE and TJO is an effective treatment for gastric varices from the portal hemodynamic point of view.
World Journal of Surgery 02/2010; 34(5):1046-51. · 2.36 Impact Factor
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ABSTRACT: To investigate the relationships between the types of esophagogastric varices and systemic hemodynamics in patients with liver cirrhosis.
Fifty-three patients with esophagogastric varices were included in this study and divided into 4 groups according esophagogastric varices type. Groups 1 and 2 were medium-size (F2-EV) and large-size esophageal varices (F3-EV), respectively. Groups 3 and 4 were medium-size (F2-GV) and large-size isolated gastric varices (F3-GV), respectively.
The cardiac indexes (CI) were 3.61 +/- 0.76, 4.65 +/- 1.11, 3.78 +/- 0.69 and 4.65 +/- 0.75 in groups 1 to 4, respectively. CI in patients with F3 varices (groups 2 and 4) were significantly higher than those in patients with F2 varices (groups 1 and 3) (p<0.01). The systemic vascular resistances (SVRI) were 2140 +/- 623, 1463 +/- 473, 1916 +/- 420 and 1504 +/- 250 in groups 1 to 4, respectively. SVRI in patients with F3 varices were significantly lower than those in patients with F2 varices (p<0.01). Plasma ammonia levels (NH3) were 78 +/- 27, 162 +/- 153, 80 +/- 27 and 138 +/- 71 in groups 1 to 4, respectively. NH3 in patients with F3 varices were significantly higher than those in patients with F2 varices (p<0.01). The arterio-venous oxygen content differences (Ca-vO2) were 2.93 +/- 0.60, 2.53 +/- 0.55, 2.67 +/- 0.54 and 2.32 +/- 0.64 in groups 1 to 4, respectively.
We conclude that the development of esophagogastric varices is accompanied by deteriorated liver function, hyperdynamic status, increased NH3 and narrowed Ca-vO2.
Hepato-gastroenterology 58(107-108):909-15. · 0.66 Impact Factor
