Division of Gastroenterology and Hepatology, University of Virginia Medical Center, Charlottesville, Virginia 22908-0708, USA.
Am J Gastroenterol. 2012 Dec;107(12):1784-90. doi: 10.1038/ajg.2012.160.
Bleeding from portal hypertension-related gastric varices arising in the cardiofundal region of the stomach presents a challenge due to the unique underlying vascular anatomy which is sometimes underappreciated in endoscopic classification schemes. They often have dominant tributaries from the splenic vein or splenic hilum and terminate in the left renal vein (spontaneous splenorenal or gastrorenal shunts). This may limit the applicability of a transjugular intrahepatic portosystemic shunt (TIPS), because of the shunt's distance from the hilum of the liver. Endoscopically, the presence of a large systemic outflow track also may influence the performance of different cyanoacrylates. However, this anatomy allows an alternative approach, balloon-occluded retrograde transvenous obliteration (BRTO), which accesses the varix via the outflow pathway. Definitive comparisons between TIPS, endoscopic cyanoacrylate, and BRTO will be challenging because the incidence of this type of varix is insufficient for large trials. Here, I provide a perspective based on existing literature, 15 years of experience with various cyanoacrylates, and 4 years of experience with BRTO.
胃底贲门区门静脉高压性胃静脉曲张出血，由于内镜分类方案有时未能充分认识到其独特的基础血管解剖结构，因此带来挑战。这些静脉曲张通常由脾静脉或脾门的主要分支供应，并终末于左肾静脉（自发性脾肾或胃肾分流）。这可能会限制经颈静脉肝内门体分流术（TIPS）的适用性，因为分流术距离肝脏门脉较远。从内镜角度来看，大的体循环流出道的存在也可能影响不同氰基丙烯酸酯的性能。但是，这种解剖结构提供了一种替代方法，即球囊阻塞逆行经静脉闭塞（BRTO），该方法通过流出道进入静脉曲张。由于这种类型的静脉曲张的发生率不足以进行大型试验，因此 TIPS、内镜氰基丙烯酸酯和 BRTO 之间的明确比较将具有挑战性。在这里，我根据现有文献、15 年各种氰基丙烯酸酯的经验以及 4 年 BRTO 的经验提供了一个观点。
