위 정맥류 출혈의 치료에서 sodium tetradecyl sulfate (STS) foam을 사용한 플러그 보조 역행성 경정맥 폐쇄술의 안전성과 효과 평가

Abstract

Purpose: To evaluate the safety and effectiveness of plug-assisted retrograde transvenous obliteration (PARTO) using sodium tetradecyl sulfate (STS) foam for the treatment of gastric variceal bleeding. Materials and methods: From June 2012 to August 2023, a retrospective analysis was conducted on 44 patients (24 men and 20 women; mean age 61 years) who had undergone PARTO using sodium tetradecyl sulfate (STS) foam. Out of the 44 patients, 36 experienced recent bleeding, and 8 had active variceal bleeding at the time of the procedure. After the procedure, patients were followed up with computed tomography (CT) or endoscopy. However, eight patients did not undergo both follow-up CT and endoscopy due to their respective individual reasons. Clinical data and follow-up examination were reviewed to evaluate technical success, as well as early and late clinical success, and to identify procedure-related complications. Results: The technical success rate was 100% (44/44). Three patients died within a few days after the procedure; hypovolemic shock (n=1), rebleeding (n=1), and progression of hepatorenal syndrome leading to multiorgan failure (n=1). This resulted in an early clinical success rate of 93.5% (41/44). All 36 patients who underwent follow-up CT scan showed complete obliteration of gastric varices with no recurrent bleeding, resulting in a late clinical success rate of 100% (36/36). In eight patients with active gastric variceal bleeding, all underwent technically successful procedures, but one patient died within an hour after the procedure. There were no major complications related to the procedure or the sclerosing agent. There were several minor complications, such as pain (n=3) and fever (n=17), which subsided within a few days with conservative treatment. Worsening of esophageal varices and ascites were observed in 7 (19.4%) and 8 (22.2%) of the 36 patients, respectively. Conclusion: PARTO using STS foam is a technically feasible, safe, and effective treatment for patients with gastric variceal bleeding, even in cases of active bleeding.