Selective Balloon-Occluded Retrograde Sclerosis of Gastric Varices Using a Coaxial Microcatheter System

The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration

“…For successful treatment, additional specialized techniques to treat minor collaterals are required. 15,18,21,23,28,30,39,40 Such techniques result in a decreased use of 5% ethanolamine oleate and may avoid sclerosant-related complications such as hemoglobinemia. In cases with Hirota's grade 3 or 4 in particular, 21 techniques such as stepwise injection of 5% ethanolamine oleate, use of high concentrated glucose or ethanol, coil embolization of minor collaterals, or double-balloon catheterization are needed.…”

“…Especially in the case of Hirota's grade 3 or 4 varices, 21 additional specialized techniques to treat minor collaterals were utilized. 15,18,21,23,28,30,39,40 If occlusion of minor collateral vessels was necessary, a 50% glucose solution, ethanol, and embolic coils were used. With or without these interventions, a 2.8-French microcatheter (Rapid transit; Johnson and Johnson, New Brunswick, NJ, USA) was introduced through a balloon catheter to the gastric varices, and 2.5-5 ml of 5% ethanolamine oleate was injected intermittently into the gastric varices under fl uoroscopy (Fig.…”

“…Summary of balloon-occluded retrograde transvenous obliteration results in patients with gastric variceal bleeding these strategies and techniques based on the hemodynamic feature,15,18,21,23,28,30,39,40 radiologists worldwide could treat patients with gastric varices with gastrorenal shunts by B-RTO. Indeed, usefulness of B-RTO has recently been reported from outside of Japan,32,33 including in the review, guideline, and educational sections of the journals Gastroenterology, Gut, and Radiographics, respectively 3,6,18,40.…”

Hepatic Encephalopathy from Dual Splenorenal Shunts Treated with Balloon-Occluded Retrograde Transvenous Obliteration by Using a Double-Balloon Technique

“…B-RTO was first introduced by Kanagawa et al (1) and, according to the recent literature (2)(3)(4)(5)(6)(7)(8), has been applied in the treatment of gastric varices with a high success rate ranging from 85% to 100%. B-RTO is a treat- To treat gastric varices or splenorenal shunts with several draining vessels, a number of techniques have been reported (9,10).…”

“…BALLOON-OCCLUDED retrograde transvenous obliteration (B-RTO) is accepted as a treatment of choice for patients with gastric varices and splenorenal shunts and is now widely performed (1)(2)(3)(4)(5)(6)(7)(8). B-RTO is indicated for gastric varices and splenorenal shunts that drain into the left renal vein through the left adrenal vein.…”