Comparison of treatment outcomes between balloon‐occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis

Lee, Shin-Jae; Kim, Seung Up; Kim, Man Deuk; Kim, Young Hwan; Kim, Gyoung Min; Park, Sung Il; Won, Jong Yun; Lee, Do Yun; Lee, Kwang Hun

doi:10.1111/jgh.13729

Cited by 40 publications

(36 citation statements)

References 28 publications

(46 reference statements)

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“…(A1) Acute HE at time of AVB does not represent a contraindication for a bleeding TIPS. (B2) In case of persistent bleeding after TIPS variceal embolization should be performed (A2); BRTO may be considered in selected cases [ 168 – 170 ]. (B2) Adjunctive variceal embolization during TIPS may be considered in patients with contrast material filling of varices after shunt creation.…”

Section: Transjugular Intrahepatic Portosystemic Shunt (Tips)mentioning

confidence: 99%

See 1 more Smart Citation

Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III)

Reiberger

Püspök²,

Schoder³

et al. 2017

Wien Klin Wochenschr

116

190

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SummaryThe Billroth III guidelines were developed during a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR) held on 18 February 2017 in Vienna. Based on international guidelines and considering recent landmark studies, the Billroth III recommendations aim to help physicians in guiding diagnostic and therapeutic strategies in patients with portal hypertension.

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Section: Transjugular Intrahepatic Portosystemic Shunt (Tips)mentioning

confidence: 99%

“…In case of persistent bleeding after TIPS variceal embolization should be performed (A2); BRTO may be considered in selected cases [ 168 – 170 ]. (B2)…”

Section: Transjugular Intrahepatic Portosystemic Shunt (Tips)mentioning

confidence: 99%

Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III)

Reiberger

Püspök²,

Schoder³

et al. 2017

Wien Klin Wochenschr

116

190

View full text Add to dashboard Cite

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“…Most recently, Lee et al . 24 showed better OS in patients who underwent BRTO, but this did not remain significant in the multivariate analysis, as the baseline liver function was better in the BRTO group than in the TIPS group.…”

Section: Discussionmentioning

confidence: 81%

Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding

et al. 2018

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Background/AimsGastric varices (GVs) are a major cause of upper gastrointestinal bleeding in patients with liver cirrhosis. The current treatments of choice are balloon-occluded retrograde transvenous obliteration (BRTO) and the placement of a transjugular intrahepatic portosystemic shunt (TIPS). We aimed to compare the efficacy and outcomes of these two methods for the management of GV bleeding.MethodsThis retrospective study included consecutive patients who received BRTO (n=157) or TIPS (n=19) to control GV bleeding from January 2005 to December 2014 at a single tertiary hospital in Korea. The overall survival (OS), immediate bleeding control rate, rebleeding rate and complication rate were compared between patients in the BRTO and TIPS groups.ResultsPatients in the BRTO group showed higher immediate bleeding control rates (p=0.059, odds ratio [OR]=4.72) and lower cumulative rebleeding rates (log-rank p=0.060) than those in the TIPS group, although the difference failed to reach statistical significance. There were no significant differences in the rates of complications, including pleural effusion, aggravation of esophageal varices, portal hypertensive gastropathy, and portosystemic encephalopathy, although the rate of the progression of ascites was significantly higher in the BRTO group (p=0.02, OR=7.93). After adjusting for several confounding factors using a multivariate Cox analysis, the BRTO group had a significantly longer OS (adjusted hazard ratio [aHR]=0.44, p=0.01) and a longer rebleeding-free survival (aHR=0.34, p=0.001) than the TIPS group.ConclusionsBRTO provides better bleeding control, rebleeding-free survival, and OS than TIPS for patients with GV bleeding.

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“…In Child-Pugh classes B and C, no significant difference was seen between the TIPS and transcatheter sclerotherapy groups [31]. Lee et al reported that the postprocedure OS after three years was longer after BRTO than after TIPS [29]. Choi et al and Sabri et al reported that the postprocedure OS after one year was higher in BRTO than in TIPS [30,32].…”

Section: Discussionmentioning

confidence: 98%

“…Forty-one articles were removed after finding duplicates. e full texts of thirty-one records were read, and nine [24][25][26][27][28][29][30][31][32] met the inclusion criteria ( Figure 1): one RCT and eight cohort studies. e specific details of the papers that were included in our study are displayed in Table 2.…”

Section: Studies Retrieved and Characteristicsmentioning

confidence: 99%

Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis

Wang

Liu

Zhao

et al. 2020

Canadian Journal of Gastroenterology and Hepatology

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Background and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have concluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are effective treatments for patients with GV. We aimed to compare the efficiency and outcomes of these two procedures in GV patients through meta-analysis. Methods. The PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched using the keywords: GV, bleeding, TIPS, and BRTO to identify relevant randomized controlled trials and cohort studies. The overall survival (OS) rate, imminent haemostasis rate, rebleeding rate, technical success rate, procedure complication rate (hepatic encephalopathy and aggravated ascites), and Child-Pugh score were evaluated. Randomized clinical trials and cohort studies comparing TIPS and BRTO for GV due to portal hypertension were included in our meta-analysis. Two independent reviewers performed data extraction and assessed the study quality. A meta-analysis was performed to calculate risk ratios (RRs), mean differences (MDs), and 95% CIs using random effects models. Results. A total of nine studies fulfilled the inclusion criteria. There was a significant difference between TIPS and BRTO in the OS rate (RR, 0.81 (95% CI, 0.66 to 0.98); P=0.03) and rebleeding rate (RR, 2.61 (95% CI, 1.75 to 3.90); P<0.00001). TIPS had a higher incidence rate of hepatic encephalopathy (RR, 16.11 (95% CI, 7.13 to 36.37); P<0.00001). There was no significant difference between TIPS and BRTO in the immediate haemostasis rate (RR, 0.99 (95% CI, 0.89 to 1.10); P=0.84), technical success rate (RR, 1.06 (95% CI, 0.98 to 1.16); P=0.16), aggravated ascites rate (RR, 0.60 (95% CI, 0.33 to 1.09); P=0.10), or Child-Pugh change (MD, 0.22 (95% CI, −0.21 to 0.65); P=0.31). Conclusions. In this meta-analysis, BRTO brought more benefits to patients, with a higher OS rate and lower rebleeding rate. BRTO is a feasible method for GVB.

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Comparison of treatment outcomes between balloon‐occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis

Abstract: Balloon-occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re-bleeding.

Cited by 40 publications

References 28 publications

Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III)

Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III)

Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding

Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis

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