Comparison among Endoscopic Variceal Obliteration, Endoscopic Band Ligation, and Balloon-occluded Retrograde Transvenous Obliteration for Treatment of Gastric Variceal Bleeding

Abstract

Background/Aims: Endoscopic variceal obliteration (EVO), endoscopic variceal ligation (EVL), and balloon-occluded retrograde transvenous obliteration (BRTO) are used to manage gastric variceal bleeding. We compared the re-bleeding rates and survival times of these modalities. Methods: The study enrolled 103 patients with suspected gastric variceal bleeding between July 2001 and May 2009. For the management of gastric variceal bleeding, 52 patients underwent EVO; 36, EVL; and 15, BRTO. We evaluated their laboratory results and vital signs, and calculated the Child score, Child classification, and Model for End-stage Liver Disease score. Rebleeding was defined as new-onset hematemesis, hematochezia, melena, or endoscopically proven bleeding. Time-to-rebleeding and survival time were examined by Kaplan-Meyer analysis. A value of p＜0.05 indicated statistical significance. Results: There were no significant differences in baseline characteristics among the three groups. The overall follow-up period averaged 65.13 months. During follow-up, rebleeding occurred in 17 patients (11 EVO, 5 EVL, and 1 BRTO). The times-to-rebleeding were 63.59, 75.79, and 51.41 months for EVO, EVL, and BRTO, respectively, and did not differ significantly (p=0.515). The median survival times were 77.42, 70.14, and 42.79 months, respectively, and also were not different significantly (p=0.978). Conclusions: There were no significant differences in the time-to-rebleeding or survival time among EVO, EVL, and BRTO. Further prospective, large-scale studies are needed. (Korean J Gastroenterol 2011;57:302-308)

Balloon‐occluded retrograde transvenous obliteration versus endoscopic injection for gastric variceal bleeding: a systematic review and meta‐analysis

“…Of the 48 articles selected for full review, 43 were excluded for not meeting the inclusion criteria or repeated data from the same study centre . Five studies (n = 453) ultimately met the inclusion criteria and were included in meta‐analysis . (Figure ) summarises the selection process.…”

Management of acute gastric varices bleeding

“…57,72,73 In two small series, BRTO had a similar initial hemostasis and lower rebleeding rate, compared with GVO or band ligation for acute GV bleeding. 72,73 The BRTO had been shown to be as effective as TIPS for acute GV bleeding, without increasing hepatic encephalopathy. 57 The BRTO had been shown to increase portal blood flow, resulting in improved liver functions.…”

“…57,72,73 It was noted that the rebleeding rate was from 0% to 15.4%. 57,72,73 In two small series, BRTO had a similar initial hemostasis and lower rebleeding rate, compared with GVO or band ligation for acute GV bleeding. 72,73 The BRTO had been shown to be as effective as TIPS for acute GV bleeding, without increasing hepatic encephalopathy.…”

“…However, few nonrandomized comparative studies with small patient numbers reported its application for acute GV bleeding. 57,72,73 Initial hemostasis of BRTO for acute GV bleeding ranges between 76.9% and 100%. 57,72,73 It was noted that the rebleeding rate was from 0% to 15.4%.…”

“…57,72,73 Initial hemostasis of BRTO for acute GV bleeding ranges between 76.9% and 100%. 57,72,73 It was noted that the rebleeding rate was from 0% to 15.4%. 57,72,73 In two small series, BRTO had a similar initial hemostasis and lower rebleeding rate, compared with GVO or band ligation for acute GV bleeding.…”