The Clinical Results of Balloon-Occluded Retrograde Transvenous Obliteration in Treatment of Gastric Varices Compared with Transjugular Intrahepatic Portosystemic Shunt

PURPOSE: To compare the clinical results of BRTO in the gastric varices with those of TIPS. MATERIALS AND METHODS: From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with that of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. Results:In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n=4), encephalopathy (n=7) and a worsening of the gastric (n=5) or esophageal varices (n=2) occurred. CONCLUSION: BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO.

A case of hemosuccus pancreaticus in arteriovenous malformation / 대한내과학회지

Hemosuccus pancreaticus describes the syndrome of gastrointestinal bleeding into the pancreatic duct, manifested by blood loss through the ampulla of Vater. Pancreatic arteriovenous malformation (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. Endoscopy is essential to rule out other causes of upper gastrointestinal bleeding. In rare cases, active bleeding is seen from the duodenal ampulla. Selective celiac angiography is the only diagnostic test. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage. We experienced a patient with upper gastrointestinal bleeding in which the diagnosis of hemosuccus pancreaticus secondary to a AVM in chronic pancreatitis was diagnosed preoperatively. We report our experience with a review of literatures.

Hepatic Angiosarcoma Mimicking Cavernous Hemangioma on Dynamic CT

A hepatic angiosarcoma is a rare primary malignant neoplasm, which accounts for only 2% of all primary hepatic tumors. The prognosis of a hepatic angiosarcoma is very poor, and most patients die within a year of the initial diagnosis. We report a case of a hepatic angiosarcoma in a 57-year-old man. Although a dynamic CT had suggested a carvenous hemangioma 12 months earlier, the tumor size increased and spontaneously ruptured, so surgical resection was mandatory. A pathological examination, including immunohistochemical studies, showed positive staining for CD34 and Factor VIII, which confirmed the diagnosis of an angiosarcoma. Although dynamic CT is an excellent modality for the diagnosis of a cavernous hemangioma of the liver, hepatic angiosarcomas should be ruled out in selected cases, because they may present with very similar CT findings to benign hemangioma.

Three Cases of Biliary Drainage in High Grade Malignant Biliary Stricture Using Soehendra Stent Retriever / 대한소화기내시경학회지

Malignant biliary or pancreatic duct stricture is dilatated using dilatating catheter or balloon catheter but a high grade stricture is difficult to dilate by general dilatating methods. Using Soehendra stent retriever is an effective method for exchanging an impacted stent. Recently, high grade malignant biliary strictures have been dilatated by Soehendra stent retriever. We report 3 cases of successful biliary drainage in high grade malignant biliary strictures using 7 Fr Soehendra stent retriever.

Electrohydaulic Lithotripsy (EHL) of Retained Common Hile Duct Stone with Choledochoscopy / 대한소화기내시경학회지

Electrohydraulic lithotripsy (EHL) is a method used to breakup the stone by electric discharge in the presence of liquid medium. Recently we experienced a case of successful common bile duct stone removal after EHL during choledochoscopy via T-tube tract, which was the first case of EHL in biliary tract stone in Korea. A 65-year-old female patient was admitted to our hospital because of generalized pruritus after cholcystectomy with T-tube insertion. Obtained cholangiogram showed retained CBD stone which was implssible to remove by Dormian basket and tto dissolute by monooctanoin. After only one session of EHL, we can disintergrat CBD stone into several small pieces and removal of stone was easily done by Basket. After Small cut endoscopic sphincterotomy (EST) remained distal impacted stone was freely passed and control choledochoscopy and cholangiogram showed no remained stone. We think that EHL may be play a potential role in removal of biliary tract stones as in urinary tract stones.