Percutaneous transhepatic occlusion for bleeding oesophageal varices

Area of Science:

• Interventional Radiology
• Gastroenterology
• Hepatology

Background:

• Esophageal varices are a serious complication of portal hypertension, often leading to life-threatening bleeding.
• Surgical interventions for bleeding varices may not be suitable for all patients, particularly those with poor hepatic function.

Purpose of the Study:

• To evaluate the efficacy and safety of transhepatic obliteration for managing bleeding esophageal varices.
• To assess the technique's utility in patients with portal hypertension who are medically unfit for surgery.

Main Methods:

• Transhepatic obliteration of esophageal varices was performed under local anesthesia using the Lunderquist et al. (1977) technique.
• The procedure was attempted in 9 patients (11 procedures) diagnosed with portal hypertension and bleeding varices.

Main Results:

• Successful obliteration was achieved in most procedures, though the left gastric vein was not entered on 2 occasions.
• Bleeding recurred within days in 2 patients and within 1-10 months in 3 other patients.
• Complications included portal vein thrombosis, ascites, pleural effusion, and 2 hospital deaths in patients with severe liver dysfunction.

Conclusions:

• Transhepatic obliteration is a viable technique for temporarily controlling esophageal variceal bleeding in patients unsuitable for surgery.
• Despite significant morbidity, it provides a crucial management option for this high-risk patient group.