BRTO assisted endoscopic Histoacryl injection in treating gastric varices with gastrorenal shunt

There have been few studies comparing percutaneous transhepatic variceal embolization (PTVE) and transjugular intrahepatic portosystemic shunt (TIPS) for the prevention of recurrent gastric variceal bleeding (GVB). Compare the outcomes of these 2 procedures in patients with GVB. A total of 74 cirrhosis patients with GVB who underwent TIPS and modified PTVE were enrolled. The rebleeding and mortality rates, portal vein pressure (PVP) variation, and rates of hepatic encephalopathy (HE) were compared between the 2 groups. A total of 43 PTVE and 31 TIPS patients were enrolled in this study. The difference of rebleeding rate in the 2 groups was not statistically significant ( P = .190). The difference of early rebleeding rates and cumulative rebleeding-free rates were all not statistically significant ( P = .256, P = .200). The difference of mortality rates in the 2 groups was not statistically significant (χ 2 = 1.206 , P = .272). The rate of HE in TIPS group was statistically higher than that in PTVE group ( P < .0001). Both PTVE and TIPS were effective for preventing rebleeding of GVs. There were no significant differences in rebleeding and mortality rates. The incidence of HE after TIPS was higher than PTVE.

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“…There have been many studies on TIPS in the treatment of EVs, but few on the treatment of GVs. [11,20–24]…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding

et al. 2019

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“…In the presence of a gastrorenal shunt, BRTO of GV has been reported as a safe and effective treatment modality for hemostasis and has a low rebleeding rate. 29,30 As BRTO does not create a hepatic bypass of portal venous return, it does not carry a risk of encephalopathy. 29 This makes BRTO an attractive alternative to TIPS patients with hepatic encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

“…29,30 As BRTO does not create a hepatic bypass of portal venous return, it does not carry a risk of encephalopathy. 29 This makes BRTO an attractive alternative to TIPS patients with hepatic encephalopathy. Major challenges in the use of BRTO are a limited availability of local expertise, and unlike ECGI, it cannot be performed at bedside in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Cyanoacrylate Glue Injection in Management of Gastric Variceal Bleeding: US Tertiary Care Center Experience

Chandra

Holm

Abiad

et al. 2018

Journal of Clinical and Experimental Hepatology

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“…Su principal ventaja por sobre BRTO es no producir progresión de varices esofágicas ni aparición de ascitis, al no aumentar la presión portal. Esto es debido a la reducción del espacio para esclerosar y al menor uso de cianoacrilato (promedio 21 mL), sin producir obliteración permanente del shunt 8,17 . Sus ventajas adicionales son que se puede realizar en ausencia de shunt gastrorrenal y presentar mínimo riesgo embólico.…”

Section: Discussionunclassified

Escleroterapia endoscópica asistida mediante balón oclusivo como tratamiento de varices gástricas cardiofúndicas de alto riesgo: Reporte de dos casos y revisión de la literatura

et al. 2017

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Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO. Flow was interrupted in the gastro-renal shunt by a femoral access in both patients. The male patient had a new bleeding two months later and died. In the female patient an endosonography performed nine months after the procedure showed absence of remaining varices.

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BRTO assisted endoscopic Histoacryl injection in treating gastric varices with gastrorenal shunt

Abstract: BRTO assisted endoscopic Histoacryl injection is effective and safe for patients with high-risk gastric varices and concurrent gastrorenal shunt.

Cited by 10 publications

References 32 publications

Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding

Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding

Endoscopic Cyanoacrylate Glue Injection in Management of Gastric Variceal Bleeding: US Tertiary Care Center Experience

Escleroterapia endoscópica asistida mediante balón oclusivo como tratamiento de varices gástricas cardiofúndicas de alto riesgo: Reporte de dos casos y revisión de la literatura

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