Conventional versus selective balloon-occluded retrograde transvenous obliteration of gastric varices

Ramy Ahmed,Moustafa H.m Othman ,Samy M Abdel-Aziz ,Hiromu Mori,Sherif Mohamed Abdel-Aal ,Miyuki Maruno,Hiro Kiyosue,Shunro Matsumoto

doi:10.1186/s43055-020-00228-9

Ramy Ahmed, Moustafa H.m Othman + Show 6 more

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https://doi.org/10.1186/s43055-020-00228-9

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Abstract

BackgroundBalloon-occluded retrograde transvenous obliteration (BRTO) is a well-established interventional radiological technique for treatment of isolated gastric varices (GV). The aim of this study is to compare outcome after different BRTO techniques, i.e., conventional, selective and superselective techniques.Fifty-nine consecutive patients underwent BRTO as a primary prophylactic treatment for GV were retrospectively categorized into group A (38 patients underwent conventional BRTO) and group B (21 patients underwent selective or superselective BRTO). Group B was sub-grouped into group B1 (11 patients underwent selective BRTO) and group B2 (10 patients underwent superselective BRTO).ResultsMedian volume of ethanol amine oleate iopamidol (EOI) was significantly higher in group A than in group B2 (14.8 Vs 7.4 ml, p = 0.03). Complete GV thrombosis was significantly lower in group B2 (50%) than in A (89.5%, p = 0.01) and B1 (100%, p = 0.01). GV bleeding rate after BRTO was significantly higher in group B2 than in group A (20% vs 0%, p = 0.04). GV recurrence rate was not significantly different between group A and B (p = 0.5) or between group A, B1 and B2 (p = 0.1). Cumulative ascites exacerbation rate was significantly higher in group A than B (p = 0.005), B1 (p = 0.03), and B2 (p = 0.03). Cumulative esophageal varices (Es.V) aggravation rate was significantly higher in group A than B (p = 0.001), B1 (p = 0.01), and B2 (p = 0.03). Volume of EOI was a significant risk factor for ascites exacerbation (p = 0.008) while shunt occlusion and pre-existing partial portal vein thrombosis were significant risk factors for Es.V aggravation (p = 0.01 and 0.03, respectively).ConclusionSelective and super-selective techniques had a lower ascites exacerbation, and Es.V aggravation rates than conventional technique. However, superselective BRTO had a lower GV complete thrombosis and higher GV bleeding rates after BRTO than other techniques.

Highlights

Balloon-occluded retrograde transvenous obliteration (BRTO) is a well-established interventional radiological technique for treatment of isolated gastric varices (GV)
There are some adverse effects reported with this technique related to the used sclerosant agent and related to the post-procedure aggravation of portal hypertension due to portosystemic shunt occlusion resulting in Es.V aggravation and ascites exacerbation [7, 9, 10]
The median volume of ethanol amine oleate iopamidol (EOI) used in group B2 patients was significantly lower than in group A patients (7.4 ml vs 14.8 ml, p = 0.03)

Summary

Introduction

Balloon-occluded retrograde transvenous obliteration (BRTO) is a well-established interventional radiological technique for treatment of isolated gastric varices (GV). The aim of this study is to compare outcome after different BRTO techniques, i.e., conventional, selective and superselective techniques. Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular interventional radiological technique adopted and widely used in many countries including Japan for isolated GV treatment with high efficacy and safety [3,4,5,6,7,8]. There are some adverse effects reported with this technique related to the used sclerosant agent (mainly ethanolamine oleate) and related to the post-procedure aggravation of portal hypertension due to portosystemic shunt occlusion resulting in Es.V aggravation and ascites exacerbation [7, 9, 10]

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