Corrigendum to ?Balloon-occluded retrograde transvenous obliteration: it is time to jump on the bandwagon?6J Hepatol 39 (2003) 294?2959

Abstract

The Author regrets that in the above Letter to the Editor an error occurred in line 16 of the Letter. It should have read ‘PPG≤12 mmHg’. The correct paragraph is printed below. We recently read with interest the article by Bosch et al. on current management of portal hypertension [1]. It has been reported that esophageal varices rarely bleed if the portal pressure gradient (PPG)<12 mmHg [1]. However, the hemodynamics of gastric varices, especially isolated fundal varices (FV), are very different from those of esophageal varices. Because most FV are associated with a developed gastrorenal shunt, portal venous pressure of patients with large FV is quite low, whereas collateral flow into the FV is abundant [2]. Transjugular intrahepatic portosystemic shunt (TIPS) is the current standard therapy for bleeding esophagogastric varices unresponsive to pharmacological and endoscopic treatment [1]. In contrast, Tripathi and colleagues showed that gastric variceal bleeding was likely to occur at a PPG≤12 mmHg, and that TIPS only improved the mortality of patients with gastric variceal bleeding at a PPG>12 mmHg [3]. Therefore, decompressive therapy such as TIPS or pharmacological treatment seems to be ineffective for FV associated with a gastrorenal shunt. Thus, obliteration of FV in a safe manner could be justifiable. Cyanoacrylate has been shown to be effective for control of acute bleeding from FV [1], but the rebleeding rate is relatively high [4]. Further, value of cyanoacrylate in large (>12 mm) FV without active bleeding is controversial due to the potential for systemic complications caused by the migration of cyanoacrylate into the inferior vena cava through a gastrorenal shunt [5].