Balloon-occluded retrograde transvenous obliteration performed in a pediatric patient with isolated gastric fundal varices |
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Authors: | Sasaki Takashi Hasegawa Toshimichi Kimura Takuya Okada Akira Murakami Takamichi Sugiura Takashi Ohsuga Keigo |
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Institution: | a Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan b Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan |
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Abstract: | BackgroundFor giant gastric varices in association with portal hypertension, endoscopic treatment often is difficult. Although balloon-occluded retrograde transvenous obliteration (B-RTO) has been performed successfully in adult cirrhotic patients, there has been no report in pediatric patients.MethodsA 10-year-old girl with biliary atresia (BA) who had been free of jaundice after hepatic portoenterostomy was detected to have isolated gastric fundal varices by routine endoscopy. They gradually enlarged up to 4 cm in diameter, showing a tense appearance, so prophylactic treatment was conducted. Magnetic resonance angiography showed the blood flow of the varices mainly drained by a large gastrorenal shunt. A balloon catheter was introduced into the gastrorenal shunt via the femoral vein and was inflated to occlude the outflow of the varices. Five percent ethanolamine oleate was injected into the varices, and the outflow occlusion was kept for more than 30 minutes. Extensive thrombosis was achieved by an additional embolotherapy after 17 months. Throughout the course, the patient has been doing well without bleeding or worsening of the liver function tests.ConclusionsB-RTO for isolated gastric fundal varices has been performed safely in a pediatric patient and seems effective in reducing the variceal size and tension. |
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Keywords: | Balloon-occluded retrograde transvenous obliteration biliary atresia gastric varices gastrorenal shunt portal hypertension |
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