Abstract
BackgroundThe rupture of gastric varices is associated with high mortality rate. Balloon-occluded retrograde transvenous obliteration (B-RTO), a minimally invasive procedure that was introduced in the mid-1990s, has been widely accepted in Japan. Several reports have indicated that B-RTO yields satisfactory results; however, few reports have discussed the recurrence of gastric varices after this therapy. The purpose of this study is to retrospectively evaluate the technical aspects of B-RTO and the recurrence of gastric varices after treatment with this procedure.MethodsB-RTO was performed in 47 patients with gastric varices, who were at a risk of variceal ruptures and who may or may not have had a history of variceal bleeding. We injected a sclerosing agent into the gastric varices for 30-60 minutes. To evaluate the therapeutic efficacy of the technique, we obtained contrast-enhanced computed tomography (CT) scans 5 days after B-RTO. As a general rule, if the gastric varices did not appear thrombosed, we repeated the procedure 7 days after the first procedure.ResultsB-RTO was a technical success in 37 patients. It was performed once in 26 patients, twice in 6 patients, thrice in 2 patients, and 4 times in 3 patients. Contrast-enhanced CT scans obtained after B-RTO showed thrombosed gastrorenal shunts in 29 patients and patent gastrorenal shunts in 8 patients. The gastric varices recurred in 2 patients who had patent gastrorenal shunts. The overall cumulative relapse-free rate of gastric varices was 90% at 5 years after B-RTO.ConclusionsB-RTO is an effective treatment modality for gastric varices. Moreover, obliteration of the gastrorenal shunt as well as the gastric varices appears to be important for the treatment of gastric varices.
Highlights
The rupture of gastric varices is associated with high mortality rate
Gastric varices can be treated by endoscopic injection therapy with cyanoacrylate, but there is a risk of migration of this compound into systemic circulation through the inferior vena cava via the gastrorenal shunt [5]
In 6 of these 10 patients, Balloon-occluded retrograde transvenous obliteration (B-RTO) could not be performed for the following reasons: (1) the gastrorenal shunt could not be occluded with the balloon catheter because the shunt was extremely large and because of rapid blood flow in the area (2 cases); (2) catheterization was difficult owing to the presence of fine and tortuous gastrocaval or gastrorenal shunts (2 cases); and (3) the gastric varices could not be visualized owing to the presence of many retroperitoneal veins (2 cases)
Summary
Balloon-occluded retrograde transvenous obliteration (B-RTO), a minimally invasive procedure that was introduced in the mid-1990s, has been widely accepted in Japan. Several reports have indicated that B-RTO yields satisfactory results; few reports have discussed the recurrence of gastric varices after this therapy. The purpose of this study is to retrospectively evaluate the technical aspects of B-RTO and the recurrence of gastric varices after treatment with this procedure. Several reports have indicated that BRTO yields satisfactory results [6,7,8,9,10,11]; few reports have discussed the recurrence of gastric varices after this therapy. The present study was conducted to evaluate the clinical outcomes of B-RTO performed for the treatment of gastric varices and to investigate the recurrence of these varices
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
