Abstract No. 262 - Balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices in 18 patients with relative contraindications for TIPS or failed TIPS in single US medical center

Abstract

Purpose Transjugular intrahepatic portosystemic shunt (TIPS), a well-established treatment for portal hypertension related gastric varices. However, it may not be suitable for some patients with portal vein thrombosis, hepatic encephalopathy and severe thrombocytopenia, etc. We retrospectively review the balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices in 18 patients with relative contraindication for TIPS or technically or clinically failed TIPS in single US medical center. Materials and Methods From Sep 2009 to Jan 2012, eighteen patients (six men and twelve women; mean age, 60.1 yrs; range, 26-85 yrs) were treated with BRTO of gastric varices in single US medical center. Indication of BRTO of gastric varices included portal vein thrombosis (n=3), large HCC (n=3), failed TIPS placement (n=2), failed bleeding control after TIPS placement (n=3), severe thrombocytopenia (n=1), old age (> 75 years) (n=3), refusal of TIPS due to hepatic encephalopathy (n=1), and status post liver transplantation (n=1), hyperbilirubinemia (n=1). Acute gastric bleeding was eight patients, prior bleeding was six patients, and impeding bleeding was four patients. Entanolamine oleate was used as sclerosant agent in four patients and 3% sodium tetradecyl sulfate (sotradecol) was used in fourteen patients. We retrospectively analyzed technical success, complication, and clinical successes (control of acute gastric bleeding, recurrence of gastric or esophageal bleeding). Results BRTO of gastric varices was successfully performed in all patients. Complication was one vein rupture causing small retroperitoneal hematoma. Acute gastric bleeding was controlled in all eight patients. Three patients were lost to follow up. During follow up (22-618 days), two patients underwent prophylactic banding of the esophageal varices. There was no recurrent bleeding from the gastric varices and there was one esophageal bleeding. Follow up CT or MRI images (65 to 618 days) and follow up upper endoscopies (34 to 682 days) showed obliteration of gastric varices. Conclusion BRTO of gastric varices can be a useful treatment for patients with relative contraindications for TIPS or technically or clinically failed TIPS.