Document Detail


Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices.
MedLine Citation:
PMID:  15362757     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The treatment of chronic portosystemic encephalopathy with esophageal varices has not yet been established. We were able to control a case of chronic portosystemic encephalopathy with esophageal varices using a combination treatment of transjugular retrograde obliteration and endoscopic embolization. A 57-year-old man came to our hospital in a confused, apathetic and tremulous state. The grade of encephalopathy was II. The plasma ammonia level was abnormally elevated to 119 microg/dL, and the ICGR15 was 59%. Endoscopic examination revealed nodular esophageal varices with cherry-red spots. There were no gastric varices. Ultrasonography and CT revealed liver cirrhosis with a splenorenal shunt. We first applied endoscopic embolization for the esophageal varices before transjugular retrograde obliteration. We injected 5% ethanolamine oleate with iopamidol retrogradely into the esophageal varices and their associated blood routes under fluoroscopy and obliterated the palisade vein, the cardiac venous plexus and left gastric vein. Transjugular retrograde obliteration was performed 14 days after endoscopic embolization. Retrograde shunt venography visualized the splenorenal shunt and communicating route to the retroperitoneal vein. There was no communicating route to the azygos vein. After obliteration of the communicating route to the retroperitoneal vein with absolute ethanol, 5% ethanolamine oleate with iopamidol was injected into the splenorenal shunt as far as the root of the posterior gastric vein. After transjugular retrograde obliteration, the encephalopathy improved to grade 0 even without the administration of lactulose and branched-chain amino acid. The plasma ammonia level and ICGR15 were reduced to 62 microg/dL and 26%. We conclude that combination treatment of transjugular retrograde obliteration and endoscopic embolization is a rational, effective and safe treatment for chronic portosystemic encephalopathy complicated with esophageal varices.
Authors:
Fumio Chikamori; Nobutoshi Kuniyoshi; Susumu Shibuya; Yasuhiro Takase
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  51     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2004 Sep-Oct
Date Detail:
Created Date:  2004-09-14     Completed Date:  2004-10-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  1379-81     Citation Subset:  IM    
Affiliation:
Department of Surgery, Kuniyoshi Hospital, Tsukuba Soai Hospital, Japan. chikamor@i-kochi.or.jp
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MeSH Terms
Descriptor/Qualifier:
Ammonia / blood
Chronic Disease
Combined Modality Therapy
Embolization, Therapeutic*
Esophageal and Gastric Varices / blood,  radiography,  therapy*
Esophagoscopy*
Ethanol / administration & dosage
Hepatic Encephalopathy / blood,  radiography,  therapy*
Humans
Injections, Intravenous
Jugular Veins / radiography
Male
Middle Aged
Oleic Acids / administration & dosage
Renal Veins / radiography
Sclerotherapy*
Splenic Vein / radiography
Treatment Outcome
Chemical
Reg. No./Substance:
0/Oleic Acids; 3282-75-5/ethanolamine oleate; 64-17-5/Ethanol; 7664-41-7/Ammonia

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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