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

Hiraga, Nobuhiko; Aikata, Hiroshi; Takaki, Shintaro; Kodama, Hiroyuki; Shirakawa, Hiroo; Kawakami, Yoshiiku; Takahashi, Shoichi; Toyota, Naoyuki; Ito, Katsuhide; Tanaka, Shinji; Kitamoto, Mikiya; Chayama, Kazuaki

doi:10.1007/s00535-007-2077-1

Cited by 85 publications

(86 citation statements)

References 54 publications

(97 reference statements)

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“…In adult cirrhotic patients, B-RTO is useful for the treatment of the gastric varices with a gastrorenal shunt, and achieves a high eradication rate, a low recurrence rate, and a fairly good prognosis with improved hepatic function [13][14][15][16][17]. On the other hand, B-RTO may elevate the portal pressure gradient due to obstruction of a large gastrorenal shunt.…”

Section: Discussionmentioning

confidence: 96%

Efficacy and safety of balloon-occluded retrograde transvenous obliteration for gastric fundal varices in children

et al. 2008

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Balloon-occluded retrograde transvenous obliteration (B-RTO) is an interventional radiologic technique that obliterates gastric fundal varices (GFV) from draining veins under balloon occlusion. Few reports have described the use of B-RTO in children. Here, we report a case of B-RTO in a 2-year-old female patient with isolated huge varices in the gastric fundus associated with portal hypertension after surgery for biliary atresia. There was no complication and thrombosis of the varices was achieved. Our results demonstrate that B-RTO is an efficacious and safe treatment for children with isolated GFV.

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Section: Discussionmentioning

confidence: 96%

Efficacy and safety of balloon-occluded retrograde transvenous obliteration for gastric fundal varices in children

et al. 2008

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“…However, BRTO requires prolonged indwelling of an occlusion balloon catheter, which makes this procedure difficult to tolerate in long-term bed-ridden patients. A permanent sclerosant can completely eradicate a gastric variceal complex, although this would increase portal hypertension (2,12,19). Therefore, it is important to determine whether vascular plug-assisted gelatin sponge embolization could eradicate gastric varices as effectively as a permanent sclerosant.…”

Section: Discussionmentioning

confidence: 99%

“…However, as BRTO requires an occlusion balloon catheter and sclerosing agents to occlude the portosystemic shunt, the indwelling catheter results in long procedural times and complications associated with the balloon (e.g., balloon rupture) (11)(12)(13).…”

Section: Balloon-occluded Retrograde Transvenous Obliteration (Brto)mentioning

confidence: 99%

“…Ethanolamine oleate (EO), the traditional sclerosing agent used in Japan and Korea, is associated with serious complications, such as pulmonary edema, disseminated intravascular coagulation, portal vein thrombosis, severe renal dysfunction, and anaphylactic reactions (5,12,13). In the absence of adequate EO concentrations and antidotes, 3% sodium tetradecyl sulfate (STS) has been used as the sclerosant of choice in the United States (14).…”

Section: Balloon-occluded Retrograde Transvenous Obliteration (Brto)mentioning

confidence: 99%

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Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Lee

Park

et al. 2016

J Korean Soc Radiol

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Purpose:To evaluate the short-term outcome of plug-assisted retrograde transvenous obliteration (PARTO) using vascular plugs and gelatin sponges in comparison with balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Materials and Methods: From January 2005 to October 2014, 171 patients were referred for management of gastric varices, of which, 52 patients with hemodynamically stable gastric varices (48 recent bleeding; 4 primary prophylaxes) were evaluated. Of these, 38 received BRTO (men/women 23/15; mean age 61.3; Child-Pugh classes A/B/C = 11/25/2) and 14 underwent PARTO (men/women 11/3; mean age 63.4; ChildPugh classes A/B/C = 9/4/1). The technical success rate, complications, variceal changes, liver function, and exacerbation of ascites/pleural effusion were compared between the 2 groups within 3 months after the procedure. Results: The technical success rates were 92.1% in the BRTO and 100% in the PARTO group. Procedure-related early complications occurred in the BRTO group alone (8%, n = 3). Among patients with technical success, follow-up CT at 1 month was available for 98% (n = 48/49). Complete thrombosis of gastric varices was achieved in 97.1% in the BRTO and 100% in the PARTO group. Worsening of esophageal varices was observed in 24% of the BRTO group alone (n = 8). The albumin level increased significantly in both groups and aspartate aminotransferase/alanine aminotransferase level improved significantly in the PARTO group (p < 0.05). Exacerbation of ascites/pleural effusion was observed in both groups (35.2% vs. 21.4%, both p > 0.05). Conclusion: PARTO appears to be equivalent to BRTO for short-term management of gastric varices.

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“…Other reported complications of BRTO include those related to the sclerosant and those related to the procedure. EO, the original agent used, was associated with renal and pulmonary complications [18][19][20]. Some of these side-effects were found to be dose-related; the use of STS foam which potentially allows for lower doses may be advantageous.…”

Section: Discussionmentioning

confidence: 99%

Bleeding Gastric Varices from Liver Cirrhosis Complicated by Hepatocellular Carcinoma Treated by Balloon Occluded Retrograde Transvenous Occlusion Obliteration using Sodium Tetradecyl Sulphate foam in an Emergent Setting

Tan¹

2017

J Med Diagn Meth

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Balloon occluded retrograde transvenous occlusion of gastric varices is a well-described technique for treating gastric varices. However, the procedure is usually performed in an elective setting, with use of conscious sedation. We report of a case which we performed, using Sodium Tetradecyl Sulphate Foam, in a middle aged man presenting with acute upper gastrointestinal bleeding secondary to gastric varices from alcoholic liver cirrhosis, complicated by hepatocellular carcinoma, with portal vein thrombosis, in an emergent setting and without conscious sedation. There was good outcome, with successful arrest of the bleeding. We discuss the use of this technique, as well as review the literature.

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

Abstract: B-RTO is useful for treatment of bleeding gastric varices, achieving high eradication of gastric varices, a low rebleeding rate, and a fairly good prognosis with improved hepatic function.

Cited by 85 publications

References 54 publications

Efficacy and safety of balloon-occluded retrograde transvenous obliteration for gastric fundal varices in children

Efficacy and safety of balloon-occluded retrograde transvenous obliteration for gastric fundal varices in children

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Bleeding Gastric Varices from Liver Cirrhosis Complicated by Hepatocellular Carcinoma Treated by Balloon Occluded Retrograde Transvenous Occlusion Obliteration using Sodium Tetradecyl Sulphate foam in an Emergent Setting

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