Long‐term results of balloon‐occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: A 10‐year experience

Akahoshi, Tomohiko; Hashizume, Makoto; Tomikawa, Morimasa; Kawanaka, Hirofumi; Yamaguchi, Shohei; Konishi, Kouzo; Kinjo, Nao; Maehara, Yoshihiko

doi:10.1111/j.1440-1746.2008.05549.x

Cited by 125 publications

(152 citation statements)

References 36 publications

(81 reference statements)

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“…11 BRTO has been used for active gastric variceal hemorrhage, which has been transiently treated by either endoscopic sclerotherapy or Sengstaken-Blakemore tubes, and preventive GV obliteration in patients who had never bled. 2 An essential prerequisite for BRTO is demonstration of a gastrorenal or gastrocaval shunt, which is found in 85% of patients with GV. Under fluoroscopic guidance, a balloon catheter is inserted into the outlet of the gastrorenal or gastrocaval shunt through a sheath placed in the right femoral vein.…”

Section: Discussionmentioning

confidence: 99%

“…2 We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV.…”

mentioning

confidence: 99%

“…BRTO has been used for active GV hemorrhage, which was transiently treated by either endoscopic sclerotherapy or Sengstaken-Blakemore tubes, recent bleeding, and preventive GV obliteration in patients who had never bled. 2 Reports of refractory variceal bleed treated with BRTO are rare. 2 We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV.…”

mentioning

confidence: 99%

“…2 Reports of refractory variceal bleed treated with BRTO are rare. 2 We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV.…”

mentioning

confidence: 99%

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Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature

Prajapati

Ranjan

Gupta

et al. 2016

Journal of Clinical and Experimental Hepatology

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Bleeding gastric varices (GV) are managed by cyanoacrylate glue injection with transjugular intrahepatic portosystemic shunt (TIPSS) as modality for treatment failure. Ulcer can form at the site of glue injection over GV and it can cause bleeding. Treatment approach for such bleed is not well described. Balloon-occluded retrograde transvenous obliteration (BRTO), TIPSS, and devascularization remain the treatment options in this scenario. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. BRTO has the benefit of increasing portal hepatic blood flow and can also be useful in patients who may not tolerate TIPSS. We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV. 1 Treatment modalities for bleeding GV are cyanoacrylate glue injection and transjugular intrahepatic portosystemic shunt (TIPSS). Balloon-occluded retrograde transvenous obliteration (BRTO) has been used as a primary treatment for acute bleeding GV. Ulcer can form at the site of glue injection over GV and it can cause bleeding. The exact prevalence of such bleeding and treatment options is not well established. BRTO has been proposed as a possible treatment option in such situation. TIPSS and devascularization remain other therapeutic options in this scenario.BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. BRTO has been used for active GV hemorrhage, which was transiently treated by either endoscopic sclerotherapy or Sengstaken-Blakemore tubes, recent bleeding, and preventive GV obliteration in patients who had never bled.2 Reports of refractory variceal bleed treated with BRTO are rare. 2 We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV. CASE 1A 44-year-old male with Child-Pugh class B cirrhosis presented with UGI bleed. He had past history of glue injection for gastric variceal bleeding one month ago. At admission, the patient had tachycardia (pulse 116/min) and hypotension (BP 86/50 mmHg) pallor. He was resuscitated with crystalloid infusion and blood transfusion and terlipressin infusion was started. After hemodynamic stabilization, he underwent emergent UGI endoscopy which showed small esophageal varices with no stigmata of bleed with large deep white based ulcer over GV at the site of previous glue injection (Figure 1). There was no unsolidified area in the varices for further glue injection. There was ongoing bleeding as indicated by persistent tachycardia and requirement of blood transfusion. Options of TIPSS or BRTO were considered and CT angiography abdomen was done to assess patency of portal vein, hepatic veins, splenic vein, and presence of gastrorenal shunt. CT showed patent portal and splenic veins and a large gastrorenal shunt d...

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Section: Discussionmentioning

confidence: 99%

“…2 We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…2 Reports of refractory variceal bleed treated with BRTO are rare. 2 We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV.…”

mentioning

confidence: 99%

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Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature

Prajapati

Ranjan

Gupta

et al. 2016

Journal of Clinical and Experimental Hepatology

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“…The patient would then return for a second and possibly a third session if the gastric varices were not completely obliterated. 9,10,19,22,24 The second strategy was to use an adjunct sclerosant such as 50% glucose solution or absolute alcohol to keep the 5% ethanolamine oleate dose/volume to less than 40 mL. 4,8,17,19 Subsequently, American interventionalists introduced a new sclerosant: 3% Sotradecol, to perform the .…”

Section: Conception and Evolution Of The Brto Proceduresmentioning

confidence: 99%

The History and Evolution of Balloon-occluded Retrograde Transvenous Obliteration (BRTO): From the United States to Japan and Back

Saad

2011

Semin intervent Radiol

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The concept of obliterating varices that complicate portal hypertension dates back to the 1970s, but its minimally invasive clinical utilization was probably lost with the advent of the transjugular intrahepatic portosystemic shunt (TIPS). The conception of retrograde obliteration of a gastrorenal shunt via the left renal vein was reported by Olson et al from the University of Indiana. However, the definition, development, technical perfection, and clinical implementation of the balloon-occluded retrograde transvenous obliteration (BRTO) occurred in Japan (by Kanagawa et al and others). The BRTO-procedure is currently undergoing a renaissance in the United States particularly for patients who are not TIPS candidates.

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Management Options for Gastric Variceal Hemorrhage

et al. 2019

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irrhosis is a serious complication of liver disease and is commonly caused by viral hepatitis and alcohol consumption. 1,2 Cirrhosis causes abnormal cellular alterations, which increase vascular resistance through the liver. Cirrhosis also comes with cellular damage, tissue fibrosis, liver hardening, nodule formation, and sinusoidal remodeling. Damage to the hepatocytes also results in a disruption of the normal equilibrium between vasodilators and vasoconstrictors and increases total blood flow into the portal system. Endogenous vasodilators such as nitric oxide increase the amount of blood flowing into the portal system by inducing splanchnic arteriolar vasodilation. Following the Ohm law, an increase in vascular resistance along with an increase in portal inflow results in an increase in portal pressure. Subsequently, cirrhosis results in clinical manifestations of portal hypertension.Owing to the variability in severity and progression, cirrhosis is commonly classified into 2 stages: compensated and decompensated. Decompensated cirrhosis is more severe and results in major complications such as ascites, jaundice, encephalopathy and variceal hemorrhage. 1,2 Thus, it is imperative to monitor the progression of compensated cirrhosis and pay close attention to predictive markers of worsening portal hypertension, such as the hepatic venous pressure gradient (HVPG). An HVPG of 10 mm Hg or more is highly

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Long‐term results of balloon‐occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: A 10‐year experience

Cited by 125 publications

References 36 publications

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature

The History and Evolution of Balloon-occluded Retrograde Transvenous Obliteration (BRTO): From the United States to Japan and Back

Management Options for Gastric Variceal Hemorrhage

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