Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Apr 28, 2016; 8(4): 390-396
Published online Apr 28, 2016. doi: 10.4329/wjr.v8.i4.390
Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices
Edward Wolfgang Lee, Naomi So, Ryan Chapman, Justin P McWilliams, Christopher T Loh, Ronald W Busuttil, Stephen T Kee
Edward Wolfgang Lee, Naomi So, Ryan Chapman, Justin P McWilliams, Christopher T Loh, Stephen T Kee, Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-743730, United States
Ronald W Busuttil, Dumont-UCLA Transplant Center, Pfleger Liver Institute, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA 90095-743730, United States
Author contributions: Lee EW and Kee ST designed research; Lee EW, So N, Chapman R, McWilliams JP and Loh CT performed research; Lee EW, So N, McWilliams JP and Loh CT analyzed data; Lee EW, So N, Chapman R, McWilliams JP, Loh CT, Busuttil RW and Kee ST wrote the paper, contributed with critical revision and editing and final approval of the final version.
Institutional review board statement: This study was reviewed and approved by the UCLA Institutional Review Board (IRB#15-000608).
Informed consent statement: The UCLA IRB waived the requirement for informed consent under 45 CFR 46.116(d) for the entire study.
Conflict-of-interest statement: No financial conflict-of-interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edward Wolfgang Lee, MD, PhD, Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095-743730, United States. edwardlee@mednet.ucla.edu
Telephone: +1-310-2678771
Received: November 26, 2015
Peer-review started: November 26, 2015
First decision: January 6, 2016
Revised: January 22, 2016
Accepted: February 16, 2016
Article in press: February 17, 2016
Published online: April 28, 2016
Processing time: 145 Days and 13.3 Hours
Abstract

AIM: To evaluate whether intra-procedural cone-beam computed tomography (CBCT) performed during modified balloon-occluded retrograde transvenous obliteration (mBRTO) can accurately determine technical success of complete variceal obliteration.

METHODS: From June 2012 to December 2014, 15 patients who received CBCT during mBRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated. Three-dimensional (3D) CBCT images were performed and evaluated prior to the end of the procedure, and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of mBRTO including: Complete occlusion/obliteration of: (1) gastrorenal shunt (GRS); (2) gastric varices; and (3) afferent feeding veins. Post-mBRTO contrast-enhanced CT was used to confirm the accuracy and diagnostic value of CBCT within 2-3 d.

RESULTS: Intra-procedural 3D-CBCT images were 100% accurate in determining the technical success of mBRTO in all 15 cases. CBCT demonstrated complete occlusion/obliteration of GRS, gastric varices, collaterals and afferent feeding veins during mBRTO, which was confirmed with post-mBRTO CT. Two patients showed incomplete obliteration of gastric varices and feeding veins on CBCT, which therefore required additional gelfoam injections to complete the procedure. No patient required additional procedures or other interventions during their follow-up period (684 ± 279 d).

CONCLUSION: CBCT during mBRTO appears to accurately and immediately determine the technical success of mBRTO. This may improve the technical and clinical success/outcome of mBRTO and reduce additional procedure time in the future.

Keywords: Gastric varices; Modified balloon-occluded retrograde transvenous obliteration; Gastric variceal bleeding; Cone-beam computed tomography; Coil-assisted retrograde transvenous obliteration

Core tip: This is a retrospective study to evaluate the feasibility, usefulness and efficacy of cone-beam computed tomography (CBCT) in modified balloon-occluded retrograde transvenous obliteration (mBRTO) procedures including coil-assisted retrograde transvenous obliteration and plug-assisted retrograde transvenous oblitearation. With an intra-procedural three-dimensional CBCT, the technical success of mBRTO was determined prior to the completion of the procedure in 100% of cases. With CBCT, a complete anatomy of gastric varices including gastrorenal shunt, gastric varices, collaterals, afferent and efferent vessels were identified easily. The CBCT may improve the technical and clinical success of mBRTO procedures and potentially reduce additional procedure time and cost.