Successful balloon-occluded retrograde transvenous obliteration for large gastric varices in combination with temporary occlusion of the splenic artery.

摘要

The closure of a gastrorenal shunt during balloon-occluded retrograde transvenous obliteration (BRTO) causes portal blood flow to switch from hepatofugal flow to hepatopetal flow (1). Such a hemodynamic change sometimes results in an insufficient amount of sclerotic agent remaining within the gastric varices during BRTO (2). We recently encountered such a situation.The institutional review board at our institution does not require approval for this type of case report. A 58-year-old woman with alcoholic liver disease was admitted for treatment of large gastric varices; there was no history of an index bleed. The Model for End-Stage Liver Disease score was 6. Endoscopic examination revealed very large gastric fundal varices without red color signs. An enlarged gastrorenal shunt draining from the gastric varices was shown on contrast-enhanced computed tomography (CT).