21 - Retrograde Transvenous Obliteration with Gelfoam for Gastric Varices Without a Sclerosant: Insights from a Single - Tertiary Institution: A Retrospective Study

Purpose: This study aims to evaluate the effectiveness of gelfoam-based retrograde transvenous obliteration, performed without Sclerosant, as a treatment strategy for large gastric varices and associated gastro-renal shunts (maximum diameter 20 mm; average 14 mm) in elective as well as emergent clinical settings and describe mid to long term clinical results.

Materials and Methods: A retrospective analysis was conducted on 45 consecutive patients (34 men, 11 women; mean age, 45 years; range- 16-70 years) who underwent retrograde transvenous obliteration between 2019 and 2025 for the management of massive gastric variceal hemorrhage after obtaining written informed consent and institutional ethics committee clearance. The primary intervention involved the use of Amplatzer™ Vascular Plugs (AVPs;) in conjunction with absorbable gelatin sponge (Gelfoam) as the embolic agent, without the addition of Sclerosants in majority of cases. Clinical and laboratory data were reviewed to assess procedural outcomes, including technical and clinical success rates, as well as associated complications. The follow up period was 5 years. The technique of retrograde obliteration with sodium tetradecyl sulfate (STS) sclerosant is an established treatment modality demonstrating high technical and clinical success with a low complication profile(1) The aim of this study is to evaluate the safety and efficacy of a modified approach—using Gelfoam alone as the embolic agent, eliminating the need for Sclerosants further making it more safer.

Results: Technical success—defined as complete occlusion of the gastro-renal shunt and full opacification of the gastric varix (GV) with gelfoam slurry—was achieved in all 45 patients (100%). Clinical success, defined as the absence of upper gastrointestinal bleeding (UGIB) during the follow-up period, was observed in all patients following the procedure. Follow-up CT obtained within 1 wk after PARTO showed complete thrombosis of GVs and portosystemic shunts in all patients (100%). Death due to other causes occurred in 5 patients. There was no immediate procedure-related complications. All cases showed successful clinical outcome during mean follow up of 3-5 years evidenced by imaging studies, endoscopy and clinical data. There were no cases of variceal bleeding or hepatic encephalopathy at the end of follow-up (mean, 3 years).

Conclusion: Retrograde transvenous obliteration using gelfoam without Sclerosant appears to be a safe and effective technique for the management of gastric variceal hemorrhage achieving a sustained bleed-free period.