Gut and Liver https://doi.org/10.5009/gnl18392 Evaluation of Treatment Response after Endoscopic Variceal Obturation with Abdominal Computed Tomography
Author Information
Han Ah Lee,1 Hyun Gil Goh,1 Tae Hyung Kim,1 Young-Sun Lee,1 Sang Jun Suh,1 Young Kul Jung,1 Hyuk Soon Choi,1 Eun Sun Kim,1 Ji Hoon Kim,1 Hyunggin An,2 Yeon Seok Seo,1 Hyung Joon Yim,1 Sung Bum Cho,3 Yoon Tae Jeen,1 Jong Eun Yeon,1 Hoon Jai Chun,1 Kwan Soo Byun,1 Soon Ho Um,1 and Chang Duck Kim1
Departments of 1Internal Medicine, 2Biostatistics, and 3Radiology, Korea University College of Medicine, Seoul, Korea

Yeon Seok Seoa and Sung Bum Chob
aDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea
Tel: +82-2-920-6608, Fax: +82-2-953-1943, E-mail: drseo@korea.ac.kr
bDepartment of Radiology, Korea University College of Medicine, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea
Tel: +82-2-920-5555, Fax: +82-2-929-3796, E-mail: anglercho@gmail.com
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

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.
Keywords: Tomography; X-ray computed; Cyanoacrylates; Esophageal and gastric varices; Ethiodized oil
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.
Keywords: Tomography; X-ray computed; Cyanoacrylates; Esophageal and gastric varices; Ethiodized oil
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