Download PDF
Digestive Disease Interventions 2019; 03(03): 214-226
DOI: 10.1055/s-0039-1694978
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

Alexander Dabrowiecki
1   Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Eric J. Monroe
2   Department of Interventional Radiology, Seattle Children's Hospital, Seattle, Washington
,
Rene Romero
3   Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Children's Pediatric Institute, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
,
Anne E. Gill
1   Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
4   Division of Interventional Radiology and Image Guided Medicine, Children's Pediatric Institute, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
,
C. Matthew Hawkins
1   Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
4   Division of Interventional Radiology and Image Guided Medicine, Children's Pediatric Institute, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

10 April 2019

06 June 2019

Publication Date:
27 August 2019 (online)

Also available at
   Permissions and Reprints

Abstract

Portal hypertension is a significant cause of morbidity and mortality in pediatric patients. Complications of portal hypertension include development of portosystemic varices. The most common type of portosystemic varices are gastroesophageal varices; however, other ectopic varices can also be a cause of recurrent, life-threatening gastrointestinal bleeding. Problematic ectopic varices include isolated gastric, anorectal, small bowel, roux-limb, and stomal varices. There are no standardized treatment guidelines on how to manage ectopic varices in children; however, new innovations in endovascular treatment options provide potential therapeutic alternatives when varices are refractory to conventional therapy. This review provides a case-based literature review for endovascular treatment of isolated gastric, anorectal, small bowel, roux-limb, and stomal ectopic varices in children (age 0-9 years) and adolescents (age 10-19 years).

Keywords

portosystemic varices - ectopic varices - venous intervention - pediatric interventions
 

  • References

  • 1 Koh C, Heller T. Approach to the diagnosis of portal hypertension. Clin Liver Dis 2012; 1 (05) 133-135
    CrossrefPubMedGoogle Scholar
  • 2 Bertino F, Hawkins CM, Shivaram G. , et al. Technical feasibility and clinical effectiveness of transjugular intrahepatic portosystemic shunt creation in pediatric and adolescent patients. J Vasc Interv Radiol 2019; 30 (02) 178-186.e5
    CrossrefPubMedGoogle Scholar
  • 3 Monroe EJ, Shin DS, Shivaram GM, Koo KSH. Pediatric transjugular intrahepatic portosystemic shunts. Dig Dis Interv 2017; 01 (04) 277-285
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Maciel MJS, Pereira OI, Motta Leal Filho JM. , et al. Peristomal variceal bleeding treated by coil embolization using a percutaneous transhepatic approach. World J Clin Cases 2016; 4 (01) 25-29
    PubMedGoogle Scholar
  • 5 Ghannam JS, Cline MR, Hage AN. , et al. Technical success and outcomes in pediatric patients undergoing transjugular intrahepatic portosystemic shunt placement: a 20-year experience. Pediatr Radiol 2019; 49 (01) 128-135
    CrossrefPubMedGoogle Scholar
  • 6 Shneider BL, Bosch J, de Franchis R. , et al; expert panel of the Children's Hospital of Pittsburgh of UPMC. Portal hypertension in children: expert pediatric opinion on the report of the Baveno v Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension. Pediatr Transplant 2012; 16 (05) 426-437
    CrossrefPubMedGoogle Scholar
  • 7 Møller S, Hobolth L, Winkler C, Bendtsen F, Christensen E. Determinants of the hyperdynamic circulation and central hypovolaemia in cirrhosis. Gut 2011; 60 (09) 1254-1259
    CrossrefPubMedGoogle Scholar
  • 8 Lebrec D, De Fleury P, Rueff B, Nahum H, Benhamou JP. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology 1980; 79 (06) 1139-1144
    CrossrefPubMedGoogle Scholar
  • 9 Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology 2004; 40 (03) 652-659
    CrossrefPubMedGoogle Scholar
  • 10 van Wessel DB, Witt M, Bax N. , et al. Variceal bleeds in patients with biliary atresia. Eur J Pediatr Surg 2018; 28 (05) 439-444
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Fagundes EDT, Ferreira AR, Roquete MLV. , et al. Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome. J Pediatr Gastroenterol Nutr 2008; 46 (02) 178-183
    CrossrefPubMedGoogle Scholar
  • 12 Arora NK, Lodha R, Gulati S. , et al. Portal hypertension in north Indian children. Indian J Pediatr 1998; 65 (04) 585-591
    CrossrefPubMedGoogle Scholar
  • 13 Pariente D, Franchi-Abella S. Paediatric chronic liver diseases: how to investigate and follow up? Role of imaging in the diagnosis of fibrosis. Pediatr Radiol 2010; 40 (06) 906-919
    CrossrefPubMedGoogle Scholar
  • 14 Poddar U, Thapa BR, Rao KL, Singh K. Etiological spectrum of esophageal varices due to portal hypertension in Indian children: is it different from the West?. J Gastroenterol Hepatol 2008; 23 (09) 1354-1357
    CrossrefPubMedGoogle Scholar
  • 15 Millis JM, Seaman DS, Piper JB. , et al. Portal vein thrombosis and stenosis in pediatric liver transplantation. Transplantation 1996; 62 (06) 748-754
    CrossrefPubMedGoogle Scholar
  • 16 Alvarez F. Portal vein complications after pediatric liver transplantation. Curr Gastroenterol Rep 2012; 14 (03) 270-274
    CrossrefPubMedGoogle Scholar
  • 17 Waits SA, Wojcik BM, Cai S, Mathur AK, Englesbe MJ. Portal vein thrombosis and outcomes for pediatric liver transplant candidates and recipients in the United States. Liver Transpl 2011; 17 (09) 1066-1072
    CrossrefPubMedGoogle Scholar
  • 18 Gana JC, Turner D, Mieli-Vergani G. , et al. A clinical prediction rule and platelet count predict esophageal varices in children. Gastroenterology 2011; 141 (06) 2009-2016
    CrossrefPubMedGoogle Scholar
  • 19 Shneider BL, de Ville de Goyet J, Leung DH. , et al. Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass: summary of the Baveno VI Pediatric Satellite Symposium. Hepatology 2016; 63 (04) 1368-1380
    CrossrefPubMedGoogle Scholar
  • 20 Corley DA, Cello JP, Adkisson W, Ko WF, Kerlikowske K. Octreotide for acute esophageal variceal bleeding: a meta-analysis. Gastroenterology 2001; 120 (04) 946-954 . Doi: 10.1053/gast.2001.22451
    CrossrefPubMedGoogle Scholar
  • 21 De Franchis R. Revising consensus in portal hypertension: report of the Baveno V Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension. J Hepatol 2010; 53 (04) 762-768
    CrossrefPubMedGoogle Scholar
  • 22 Khan Sarin AW, Le Mair AS, Gangl A, Khan Bjorkman R, Eliakim R, Bektaeva SK, Sarin S, Fedail JH, Krabshuis AW, Le Mair AD. . World Gastroenterology Organisation Global Guidelines Esophageal Varices; 2014 http://www.spg.pt/wp-content/uploads/2015/11/2014-ESOPHAGEAL-VARICES.pdf . Accessed January 24, 2019
    PubMed
  • 23 Lakhoo J, Bui JT, Lokken RP, Ray Jr CE, Gaba RC. Transjugular intrahepatic portosystemic shunt creation and variceal coil or plug embolization ineffectively attain gastric variceal decompression or occlusion: results of a 26-patient retrospective study. J Vasc Interv Radiol 2016; 27 (07) 1001-1011
    CrossrefPubMedGoogle Scholar
  • 24 Fidelman N, Kwan SW, LaBerge JM, Gordon RL, Ring EJ, Kerlan Jr RK. The transjugular intrahepatic portosystemic shunt: an update. AJR Am J Roentgenol 2012; 199 (04) 746-755
    CrossrefPubMedGoogle Scholar
  • 25 Rosen D, Chu J, Patel R, Moon J, Iyer K, Arnon R. Balloon-occluded retrograde transvenous obliteration for recurrent fundal gastric variceal bleeding in an adolescent. Pediatr Transplant 2014; 18 (06) E193-E196
    CrossrefPubMedGoogle Scholar
  • 26 Hisamatsu C, Kawasaki R, Yasufuku M, Maeda K. Efficacy and safety of balloon-occluded retrograde transvenous obliteration for gastric fundal varices in children. Pediatr Surg Int 2008; 24 (10) 1141-1144
    CrossrefPubMedGoogle Scholar
  • 27 Nagata H, Yamamura K, Ikeda K, Ihara K, Hara T. Balloon-occluded retrograde transvenous obliteration for congenital portosystemic venous shunt: report of two cases. Pediatr Int 2012; 54 (03) 419-421
    CrossrefPubMedGoogle Scholar
  • 28 Hwang J-B, Jung EY, Park W-H, Kim YH, Kim AS. Balloon-occluded retrograde transvenous obliteration treats hepatic dysfunction and gastric varices. J Pediatr Gastroenterol Nutr 2011; 52 (02) 219-221
    CrossrefPubMedGoogle Scholar
  • 29 Sasaki T, Hasegawa T, Kimura T. , et al. Balloon-occluded retrograde transvenous obliteration performed in a pediatric patient with isolated gastric fundal varices. Journal of Pediatric Surgery 2004; 39 (01) 130-132
    CrossrefPubMedGoogle Scholar
  • 30 Saad WEA, Anderson CL, Patel RS. , et al. Management of gastric varices in the pediatric population with balloon-occluded retrograde transvenous obliteration (BRTO) utilizing sodium tetradecyl sulfate foam sclerosis with or without partial splenic artery embolization. Cardiovasc Intervent Radiol 2015; 38 (01) 236-241
    CrossrefPubMedGoogle Scholar
  • 31 Shigeta T, Kasahara M, Sakamoto S. , et al. Balloon-occluded retrograde transvenous obliteration for a portosystemic shunt after pediatric living-donor liver transplantation. Journal of Pediatric Surgery 2011; 46 (06) e19-e22
    PubMedGoogle Scholar
  • 32 Hayashi S, Saeki S, Ushini T. Gastric fundic varices: hemodynamics and non-surgical treatment. Dig Endosc 2005; 17 (03) 198-202
    CrossrefPubMedGoogle Scholar
  • 33 Takahashi T, Yoshida H, Mamada Y, Taniai N, Tajiri T. Balloon-occluded retrograde transvenous obliteration for gastric varices in a child with extrahepatic portal venous obstruction. J Nippon Med Sch 2009; 76 (03) 173-178
    CrossrefPubMedGoogle Scholar
  • 34 Kiyosue H, Tanoue S, Kondo Y. , et al. Balloon-occluded retrograde transvenous obliteration of complex gastric varices assisted by temporary balloon occlusion of the splenic artery. J Vasc Interv Radiol 2011; 22 (07) 1045-1048
    CrossrefPubMedGoogle Scholar
  • 35 Yoshimatsu R, Yamagami T, Tanaka O, Miura H, Hashiba M. Hemodynamic changes after balloon occlusion of the splenic artery during balloon-occluded retrograde transvenous obliteration for gastric varices. J Vasc Interv Radiol 2012; 23 (09) 1207-1212
    CrossrefPubMedGoogle Scholar
  • 36 Wada H, Hashizume M, Yamaga H, Kitano S, Sugimachi K. Hemodynamic and morphological changes in the dog kidney after injection of 5% ethanolamine oleate into the superior vena cava. Eur Surg Res 1990; 22 (02) 63-70
    CrossrefPubMedGoogle Scholar
  • 37 Deuel JW, Schaer CA, Boretti FS. , et al. Hemoglobinuria-related acute kidney injury is driven by intrarenal oxidative reactions triggering a heme toxicity response. Cell Death Dis 2016; 7 (01) e2064
    CrossrefPubMedGoogle Scholar
  • 38 Imai Y, Nakazawa M, Ando S, Sugawara K, Mochida S. Long-term outcome of 154 patients receiving balloon-occluded retrograde transvenous obliteration for gastric fundal varices. J Gastroenterol Hepatol 2016; 31 (11) 1844-1850
    CrossrefPubMedGoogle Scholar
  • 39 Saad WEA. The history and evolution of balloon-occluded retrograde transvenous obliteration (brto): from the United States to Japan and back. Semin Intervent Radiol 2011; 28 (03) 283-287
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Satapathy SK, Sanyal AJ. Nonendoscopic management strategies for acute esophagogastric variceal bleeding. Gastroenterol Clin North Am 2014; 43 (04) 819-833
    CrossrefPubMedGoogle Scholar
  • 41 Kumamoto M, Toyonaga A, Inoue H. , et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol 2010; 25 (06) 1129-1135
    CrossrefPubMedGoogle Scholar
  • 42 Shimoda R, Horiuchi K, Hagiwara S. , et al. Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging 2005; 30 (03) 306-313
    CrossrefPubMedGoogle Scholar
  • 43 Saad WE, Chick JFB, Srinivasa RN. , et al. Two-year outcomes of balloon-occluded retrograde transvenous obliteration of gastric varices in liver transplant recipients: a multi-institutional study. Diagn Interv Imaging 2017; 98 (11) 801-808
    CrossrefPubMedGoogle Scholar
  • 44 Heaton ND, Davenport M, Howard ER. Incidence of haemorrhoids and anorectal varices in children with portal hypertension. Br J Surg 1993; 80 (05) 616-618
    CrossrefPubMedGoogle Scholar
  • 45 Hosking SW, Smart HL, Johnson AG, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet 1989; 1 (8634): 349-352
    PubMedGoogle Scholar
  • 46 Shudo R, Yazaki Y, Sakurai S, Uenishi H, Yamada H, Sugawara K. Clinical study comparing bleeding and nonbleeding rectal varices. Endoscopy 2002; 34 (03) 189-194
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Robertson M, Thompson AI, Hayes PC. The Management of bleeding from anorectal varices. Curr Hepatol Rep 2017; 16 (04) 406-415
    PubMedGoogle Scholar
  • 48 Kimura T, Haruta I, Isobe Y. , et al. A novel therapeutic approach for rectal varices: a case report of rectal varices treated with double balloon-occluded embolotherapy. Am J Gastroenterol 1997; 92 (05) 883-886
    PubMedGoogle Scholar
  • 49 Okazaki H, Higuchi K, Shiba M. , et al. Successful treatment of giant rectal varices by modified percutaneous transhepatic obliteration with sclerosant: report of a case. World J Gastroenterol 2006; 12 (33) 5408-5411
    CrossrefPubMedGoogle Scholar
  • 50 Watanabe K, Imai Y, Takaya H. , et al. A case of liver cirrhosis due to hepatits C virus infection complicating giant anorectal varices treated with balloon-occluded retrograde transvenous obliteration. Clin J Gastroenterol 2011; 4 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 51 Minamiguchi H, Kawai N, Sato M. , et al. Successful treatment of endoscopically unmanageable rectal varices by balloon-occluded antegrade transvenous sclerotherapy followed by microcoil embolization. J Vasc Interv Radiol 2013; 24 (09) 1399-1403
    CrossrefPubMedGoogle Scholar
  • 52 Shin DS, Kim AG, Ingraham CR. Balloon-occluded antegrade transvenous obliteration via transjugular intrahepatic access for bleeding rectal varices. Radiol Case Rep 2019; 14 (07) 805-808
    CrossrefPubMedGoogle Scholar
  • 53 Ibukuro K, Kojima K, Kigawa I. , et al. Embolization of rectal varices via a paraumbilical vein with an abdominal wall approach in a patient with massive ascites. J Vasc Interv Radiol 2009; 20 (09) 1259-1261
    CrossrefPubMedGoogle Scholar
  • 54 Arai H, Kobayashi T, Takizawa D, Toyoda M, Takayama H, Abe T. Transileocolic vein obliteration for bleeding rectal varices with portal thrombus. Case Rep Gastroenterol 2013; 7 (01) 75-81
    CrossrefPubMedGoogle Scholar
  • 55 Abdel-Aal AK, Dawoud N, Moustafa AS, Hamed MF, Saddekni S. Percutaneous transhepatic embolization of bleeding rectal varices using a new embolic and sclerotic mixture augmented by Amplatzer Vascular Plug 2. J Radiol Case Rep 2016; 10 (09) 44-51
    PubMedGoogle Scholar
  • 56 Ohta M, Hashizume M, Kawanaka H. , et al. Complications of percutaneous transhepatic catheterization of the portal venous system in patients with portal hypertension. J Gastroenterol Hepatol 1996; 11 (07) 630-634
    CrossrefPubMedGoogle Scholar
  • 57 Chu J, Kerkar N, Miloh TA. , et al. Roux-en-Y loop varices in children with portal hypertension after liver transplantation: an unusual cause of “obscure” gastrointestinal bleeding. Pediatr Transplant 2011; 15 (08) E156-E161
    CrossrefPubMedGoogle Scholar
  • 58 Bass LM, Kim S, Superina R, Mohammad S. Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension. Pediatr Transplant 2017; 21 (01) e12818
    CrossrefPubMedGoogle Scholar
  • 59 Sasamoto A, Kamiya J, Nimura Y, Nagino M. Successful embolization therapy for bleeding from jejunal varices after choledochojejunostomy: report of a case. Surg Today 2010; 40 (08) 788-791
    CrossrefPubMedGoogle Scholar
  • 60 Norton ID, Andrews JC, Kamath PS. Management of ectopic varices. Hepatology 1998; 28 (04) 1154-1158
    CrossrefPubMedGoogle Scholar
  • 61 Watanabe N, Toyonaga A, Kojima S. , et al. Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension. Hepatol Res 2010; 40 (08) 763-776
    CrossrefPubMedGoogle Scholar
  • 62 Sonomura T, Horihata K, Yamahara K. , et al. Ruptured duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration: usefulness of microcatheters. AJR Am J Roentgenol 2003; 181 (03) 725-727
    CrossrefPubMedGoogle Scholar
  • 63 Saad WEA, Lippert A, Saad NE, Caldwell S. Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management. Tech Vasc Interv Radiol 2013; 16 (02) 158-175
    PubMedGoogle Scholar
  • 64 Tominaga K, Montani A, Kuga T. , et al. Combined balloon-occluded embolization for treatment of concurrent duodenal, gastric, and esophageal varices: a case report. Gastrointestinal Endoscopy 2001; 53 (06) 665-668
    CrossrefPubMedGoogle Scholar
  • 65 Linder S, Wiechel KL. Duodenal varicose veins. Surg Endosc 1991; 5 (01) 31-35
    CrossrefPubMedGoogle Scholar
  • 66 Kochar N, Tripathi D, McAvoy NC, Ireland H, Redhead DN, Hayes PC. Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts. Aliment Pharmacol Ther 2008; 28 (03) 294-303
    CrossrefPubMedGoogle Scholar
  • 67 Zamora CA, Sugimoto K, Tsurusaki M. , et al. Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis. Eur Radiol 2006; 16 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 68 Saad WE, Lippert A, Schwaner S, Al-Osaimi A, Sabri S, Saad N. Management of bleeding duodenal varices with combined tips decompression and trans-TIPS transvenous obliteration utilizing 3% sodium tetradecyl sulfate foam sclerosis. J Clin Imaging Sci 2014; 4: 67
    PubMedGoogle Scholar
  • 69 Chick JFB, Jo A, Dasika N, Saad WE, Srinivasa RN. Transsplenic endovascular recanalization and stenting of a completely occluded portal vein with jejunal variceal embolization in a pediatric liver transplant recipient. Pediatr Radiol 2017; 47 (08) 1012-1015
    CrossrefPubMedGoogle Scholar
  • 70 Pimpalwar S, Chinnadurai P, Hernandez A, Kukreja K, Siddiqui S, Justino H. Trans-splenic access for portal venous interventions in children: do benefits outweigh risks?. Cardiovasc Intervent Radiol 2018; 41 (01) 87-95
    CrossrefPubMedGoogle Scholar
  • 71 Yoshimatsu R, Yamagami T, Ishikawa M. , et al. Embolization therapy for bleeding from jejunal loop varices due to extrahepatic portal vein obstruction. Min Invas Ther & Allied Techno 2016; 25 (01) 57-61
    PubMedGoogle Scholar
  • 72 Sato T, Yasui O, Kurokawa T, Hashimoto M, Asanuma Y, Koyama K. Jejunal varix with extrahepatic portal obstruction treated by embolization using interventional radiology: report of a case. Surg Today 2003; 33 (02) 131-134
    CrossrefPubMedGoogle Scholar
  • 73 Saeki Y, Ide K, Kakizawa H, Ishikawa M, Tashiro H, Ohdan H. Controlling the bleeding of jejunal varices formed at the site of choledochojejunostomy: report of 2 cases and a review of the literature. Surg Today 2013; 43 (05) 550-555
    CrossrefPubMedGoogle Scholar
  • 74 Shim DJ, Shin JH, Ko G-Y. , et al. Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery. Acta Radiol 2017; 58 (04) 423-429
    CrossrefPubMedGoogle Scholar
  • 75 Choi JW, Kim H-C, Jae HJ. , et al. Transcatheter embolotherapy with N-butyl cyanoacrylate for ectopic varices. Cardiovasc Intervent Radiol 2015; 38 (02) 344-351
    CrossrefPubMedGoogle Scholar
  • 76 Read AJ, Appelman HD, DiMagno MJ. Massive jejunal bleeding from an unlikely source. Clin Gastroenterol Hepatol 2016; 14 (02) A25-A26
    PubMedGoogle Scholar
  • 77 Wiesner RH, LaRusso NF, Dozois RR, Beaver SJ. Peristomal varices after proctocolectomy in patients with primary sclerosing cholangitis. Gastroenterology 1986; 90 (02) 316-322
    CrossrefPubMedGoogle Scholar
  • 78 Kabeer MA, Jackson L, Widdison AL, Maskell G, Mathew J. Stomal varices: a rare cause of stomal hemorrhage. A report of three cases. Ostomy Wound Manage 2007; 53 (08) 20-22 , 24, 26 passim
    PubMedGoogle Scholar
  • 79 Saad WE, Saad NE, Koizumi J. Stomal varices: management with decompression tips and transvenous obliteration or sclerosis. Tech Vasc Interv Radiol 2013; 16 (02) 176-184
    PubMedGoogle Scholar
  • 80 Arulraj R, Mangat KS, Tripathi D. Embolization of bleeding stomal varices by direct percutaneous approach. Cardiovasc Intervent Radiol 2011; 34 (Suppl. 02) S210-S213
    CrossrefPubMedGoogle Scholar
  • 81 Yao D-H, Luo X-F, Zhou B, Li X. Ileal conduit stomal variceal bleeding managed by endovascular embolization. World J Gastroenterol 2013; 19 (44) 8156-8159
    CrossrefPubMedGoogle Scholar
  • 82 Sengodan P, Anna K, Reed S, Shah B, Jain A, Kyprianou A. A case of recurrent bleeding stomal varix controlled using embolization with a liquid copolymer: an effective therapy for palliation. J Palliat Med 2014; 17 (01) 85-87
    CrossrefPubMedGoogle Scholar
  • 83 Samaraweera RN, Feldman L, Widrich WC. , et al. Stomal varices: percutaneous transhepatic embolization. Radiology 1989; 170 (3 Pt 1): 779-782
    CrossrefPubMedGoogle Scholar
  • 84 Thouveny F, Aubé C, Konaté A, Lebigot J, Bouvier A, Oberti F. Direct percutaneous approach for endoluminal glue embolization of stomal varices. J Vasc Interv Radiol 2008; 19 (05) 774-777
    CrossrefPubMedGoogle Scholar
  • 85 Sabri SS, Swee W, Turba UC. , et al. Bleeding gastric varices obliteration with balloon-occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam. J Vasc Interv Radiol 2011; 22 (03) 309-316 , quiz 316
    CrossrefPubMedGoogle Scholar
  • 86 Hiraga N, Aikata H, Takaki S. , et al. The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol 2007; 42 (08) 663-672
    CrossrefPubMedGoogle Scholar
  • 87 Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol 2001; 12 (03) 327-336
    CrossrefPubMedGoogle Scholar
  • 88 Sauer BG, Sabri SS, Shami VM, Al-Osaimi AMS. Balloon-occluded retrograde transvenous obliteration (BRTO): follow-up and postprocedural imaging. Semin Intervent Radiol 2011; 28 (03) 325-332
    Article in Thieme ConnectPubMedGoogle Scholar
  • 89 Wang AJ, Li BM, Zheng XL, Shu X, Zhu X. Utility of endoscopic ultrasound in the diagnosis and management of esophagogastric varices. Endosc Ultrasound 2016; 5 (04) 218-224
    CrossrefPubMedGoogle Scholar
  • 90 Saraireh HA, Bilal M, Singh S. Role of endoscopic ultrasound in liver disease: where do we stand in 2017?. World J Hepatol 2017; 9 (24) 1013-1021
    CrossrefPubMedGoogle Scholar
  • 91 El-Shabrawi M, El-Shabrawi MHF, Isa M, Kamal NM. Management of portal hypertension in children: a focus on variceal bleeding. J Gastroenterol Hepatol Res 2012; 1 (02) 20-26
    PubMedGoogle Scholar
  • 92 Vogel CB. Pediatric portal hypertension: A review for primary care. Nurse Pract 2017; 42 (05) 35-42
    PubMedGoogle Scholar
  • 93 Giouleme O, Theocharidou E. Management of portal hypertension in children with portal vein thrombosis. J Pediatr Gastroenterol Nutr 2013; 57 (04) 419-425
    CrossrefPubMedGoogle Scholar
  • 94 Kirby JM, Cho KJ, Midia M. Image-guided intervention in management of complications of portal hypertension: more than TIPS for success. Radiographics 2013; 33 (05) 1473-1496
    CrossrefPubMedGoogle Scholar
  • 95 Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16 (06) 1343-1349
    CrossrefPubMedGoogle Scholar