Davis J, Chun AK, Borum ML. Could there be light at the end of the tunnel? Mesocaval shunting for refractory esophageal varices in patients with contraindications to transjugular intrahepatic portosystemic shunt. World J Hepatol 2016; 8(19): 790-795 [PMID: 27429715 DOI: 10.4254/wjh.v8.i19.790]
Corresponding Author of This Article
Marie L Borum, MD, EdD, MPH, Director of the Division of Gastroenterology and Liver Disease, George Washington University, 2150 Pennsylvania Avenue, NW Suite 3-405, Washington, DC 20037, United States. mborum@mfa.gwu.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jul 8, 2016; 8(19): 790-795 Published online Jul 8, 2016. doi: 10.4254/wjh.v8.i19.790
Could there be light at the end of the tunnel? Mesocaval shunting for refractory esophageal varices in patients with contraindications to transjugular intrahepatic portosystemic shunt
Jessica Davis, Albert K Chun, Marie L Borum
Jessica Davis, Department of Internal Medicine, George Washington University, Washington, DC 20037, United States
Albert K Chun, Department of Radiology, George Washington University, Washington, DC 20037, United States
Marie L Borum, Division of Gastroenterology and Liver Diseases, George Washington University, Washington, DC 20037, United States
Author contributions: Davis J wrote the manuscript; Chun AK provided fluoroscopic images; Borum ML provided endoscopic images; Chun AK and Borum ML revised the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marie L Borum, MD, EdD, MPH, Director of the Division of Gastroenterology and Liver Disease, George Washington University, 2150 Pennsylvania Avenue, NW Suite 3-405, Washington, DC 20037, United States. mborum@mfa.gwu.edu
Telephone: +1-202-7412160 Fax: +1-202-7412169
Received: March 25, 2016 Peer-review started: March 25, 2016 First decision: May 17, 2016 Revised: May 19, 2016 Accepted: June 14, 2016 Article in press: June 16, 2016 Published online: July 8, 2016 Processing time: 103 Days and 6.3 Hours
Abstract
Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement.
Core tip: Cirrhotic patients who have recurrent variceal hemorrhage despite medical and endoscopic therapy have limited options if they are not transjugular intrahepatic portosystemic shunting candidates. One promising new method to decrease portal pressures while avoiding surgical shunt placement is mesocaval shunt placement with fluoroscopic guidance. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement.
