BACKGROUND/RATIONALE OF STUDY: Analyze safety and efficacy of angiographic-occlusion-with-
sclerotherapy/
embolotherapy-without-transjugular-intrahepatic-
portosystemic-shunt (
TIPS) for duodenal
varices. Although
TIPS is considered the best intermediate-to-long term
therapy after failed endoscopic
therapy for
bleeding varices, the options are not well-defined when
TIPS is relatively contraindicated, with scant data on
alternative therapies due to relative rarity of duodenal
varices. Prior cases were identified by computerized literature search, supplemented by one illustrative case. Favorable clinical outcome after angiography defined as no rebleeding during follow-up, without major procedural complications.
RESULTS: Thirty-two cases of duodenal
varices treated by angiographic-occlusion-with-
sclerotherapy/
embolotherapy- without-
TIPS were analyzed. Patients averaged 59.5 ± 12.2 years old (female = 59%). Patients presented with melena-16,
hematemesis & melena-5, large varices-5, growing varices-2, ruptured varices-1, and other- 3. Twenty-nine patients had
cirrhosis; etiologies included: alcoholism-11,
hepatitis C-11,
primary biliary cirrhosis- 3,
hepatitis B-2, Budd-Chiari-1, and idiopathic-1. Three patients did not have
cirrhosis, including hepatic
metastases from rectal cancer-1, Wilson's disease-1, and chronic liver dysfunction-1. Thirty-one patients underwent esophagogastroduodenoscopy before therapeutic angiography, including fifteen undergoing endoscopic variceal
therapy. Therapeutic angiographic techniques included balloon-occluded retrograde-transvenous-obliteration (BRTO) with
sclerotherapy and/or embolization-21, DBOE (double-balloon-occluded-embolotherapy)-5, and other-6. Twenty-eight patients (87.5%; 95%-confidence interval: 69-100%) had favorable clinical outcomes after therapeutic angiography. Three patients were therapeutic failures: rebleeding at 0, 5, or 10 days after
therapy. One major complication (Enterobacter
sepsis) and one minor complication occurred.
CONCLUSIONS: This work suggests that angiographic-occlusion-with
sclerotherapy/
embolotherapy-without-
TIPS is relatively effective (~90% hemostasis-rate), and relatively safe (3% major-complication-rate). This
therapy may be a useful treatment option for duodenal
varices when endoscopic
therapy fails and
TIPS is relatively contraindicated.