A Case of Gastric Varices Safely Eradicated by Percutaneous Transhepatic Portography and Endoscopic Injection Therapy

A 59-year-old woman underwent a medical check-up. Liver cirrhosis and esophageal varices were diagnosed, and the patient was admitted to our hospital on May 10, 1996. Endoscopic examination showed the presence of esophageal varices (EV) and gastric varices (GV) with red-color signs. Magnetic resonance (MR) angiography and arterioportography revealed that the EV and GV received blood from the left gastric vein and short gastric vein, respectively. The blood drainage route was not demonstrated by these examinations. EV were eradicated by both EVL and endoscopic injection therapy (EIS) . We performed percutaneous transhepatic portography (PTP) to obtain further information on the GV. PTP showed that the pericardial vein, not the gastrorenal shunt, was the blood drainage route of the GV. We concluded that EIS is a better technique than transvenous obliteration for the eradication of GV in this case. Cyanoacrylate was injected into the blood drainage route of GV located at the epicardia. Ethanolamine oleate (EO) was administered into the blood supply route of GV. EIS was performed three times, and the eradication of GV was confirmed by MR angiography after 3 months. This case demonstrated that detailed information on GV obtained by PTP permits EIS to be performed safely.