Recent development of balloon‐occluded retrograde transvenous obliteration

Kobayakawa, Masao; Ohnishi, S. Tsuyoshi; Suzuki, Hidekazu

doi:10.1111/jgh.14463

Cited by 17 publications

(16 citation statements)

References 46 publications

(119 reference statements)

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“…This occlusion is achieved by the injection of a sclerosing agent into varix. Even though it has been common practice for the treatment of gastric varices in Asia over the last two decades, BRTO has been gaining more popularity in the US lately [13].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Gastric Variceal Hemorrhage

Ravi

Oza

Sharma

et al. 2019

Cureus

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Acute upper gastrointestinal (GI) bleeding is a commonly encountered condition that can potentially be life-threatening. Endoscopy is the diagnostic modality of choice, but it is important to recognize it's shortcomings. We introduce a 61-year-old female who presented with hematemesis and syncope. She had a history of recurrent episodes of hematemesis and hospitalizations for the preceding 18 months, for which multiple endoscopies had been performed but had failed to demonstrate a source. A repeat esophagogastroduodenoscopy (EGD) performed at our facility was unremarkable. A CT scan demonstrated a lobulated mass-like filling defect in the gastric cardia consistent with solitary varix with an abnormal fold pattern. An upper GI follow-through series was performed to better characterize this varix. The patient subsequently underwent balloon-occluded retrograde transvenous obliteration with successful control of the source of bleeding. It is important to keep in mind that EGD while being the gold standard for the diagnosis of varices, has its limitations, and should be augmented with the use of non-traditional diagnostic modalities such as CT scans or radionuclide imaging.

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Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Gastric Variceal Hemorrhage

Ravi

Oza

Sharma

et al. 2019

Cureus

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“…Cyanoacrylate (glue) treatment uses N-butyl-2-cyanoacrylate. Following administration, cyanoacrylate is polymerized and exerts its effects instantly within 20 s [13,14,15,16,17,18,19,20,21,22,23,24]. The fatty contrast agent lipiodol ultra-fluid (Therapex, Canada) is used to avoid occlusion in the endoscopy channel during the procedure.…”

Section: Treatmentmentioning

confidence: 99%

“…Radiologic (endovascular) treatments include a transjugular intrahepatic portosystemic shunt (TIPS) and BRTO or a TIPS + BRTO combination [18,19,20,21,22].…”

Section: Treatmentmentioning

confidence: 99%

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Current Approaches to the Treatment of Gastric Varices: Glue, Coil Application, TIPS, and BRTO

Göral

Yılmaz

2019

Medicina

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Gastric varices are less common than esophageal varices, and their treatment is quite challenging. Gastric varix bleedings (GVB) occur less frequently than esophageal varix (EV) bleedings and represent 10% to 30% of all variceal bleedings. They are; however, more severe and are associated with high mortality. Re-bleeding may occur in 35% to 90% of cases after spontaneous hemostasis. GV bleedings represent a serious clinical problem compared with esophageal varices due to their location. Sclerotherapy and band ligation, in particular, are less effective. Based on the anatomic site and location, treatment differs from EV and is categorized into two groups (i.e., endoscopic or radiologic treatment). Surgical management is used less frequently. Balloon-occluded retrograde transvenous obliteration (BRTO) and cyanoacrylate are safe but there is a high risk of re-bleeding. Portal pressure elevates following BRTO and leads to worsening of esophageal varix pressure. Other significant complications may include hemoglobinuria, abdominal pain, fever, and pleural effusion. Shock and atrial fibrillation are major complications. New and efficient treatment modalities will be possible in the future.

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“…Radiological intervention methods also have demonstrated efficiency and safety in managing GVB [13][14][15][16]. Transjugular intrahepatic portosystemic shunt (TIPS), a minimally-invasive interventional surgery, can decompress the portal circulation and is regarded as the primary approach for GVB management in the West (United States and Europe) [17].…”

Section: Introductionmentioning

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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Recent development of balloon‐occluded retrograde transvenous obliteration

Cited by 17 publications

References 46 publications

An Unusual Presentation of Gastric Variceal Hemorrhage

An Unusual Presentation of Gastric Variceal Hemorrhage

Current Approaches to the Treatment of Gastric Varices: Glue, Coil Application, TIPS, and BRTO

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

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