Efficacy of Balloon-occluded Retrograde Transvenous Obliteration, Percutaneous Transhepatic Obliteration and Combined Techniques for the Management of Gastric Fundal Varices and Hepatic Encephalopathy

Abstract

Purpose: Currently, several types of therapeutic procedures, including surgical, endoscopic, and radiological interventions, are available for the treatment of gastric varices and hepatic encephalopathy. Although interventional embolitherapy has been applied for the treatment of gastric varices and hepatic encephalopathy, treatment indications and a recommended embolitherapeutic strategy have not yet been established. In this study, we evaluated the effect of three interventional treatments involving transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy; the efficacy and adverse effects of these methods were compared. Methods: From 2003 to 2010, 25 patients with gastric fundal varices or hepatic encephalopathy underwent interventional radiologic embolitherapy in our hospital. Of the 25 patients, 15 were with GV, 10 were with hepatic encephalopathy. Four were treated with the balloon-occluded retrograde transvenous obliteration (BRTO) procedure, 13 were with the percutaneous transhepatic obliteration (PTO) procedure, and 8 were with the combined BRTO and PTO therapy “double balloon occluded embolization (DBOE)”. We examined the survival rate, recurrence rate of varices or encephalopathy, swelling of esophageal varices and complications in each group. Results: The BRTO, PTO, and DBOE were technically successful in 75% (3/4), 100% (13/13), and 100% (8/8) patients, respectively. Gastric varices disappeared or decreased in size, and hepatic encephalopathy was partially or completely improved in all patients. Recurrent gastric varices were found in 1 patient in the DBOE group. Recurrent encephalopathy was observed in 3 patients in the PTO group. Swelling esophageal varices were seen in 1 patient in the BRTO group, 2 patients in the PTO group and 2 patients in the DBOE group, but these varices could be treated with endoscopic injectional sclerotherapy. As a severe complication, there was 1 case of intraabdominal hemorrhage in the DBOE group and was stopped with coil embolization. Other mild complications were transient ascites, fever and abdominal pain. The 1- and 3-year survival rates were75% and 75% in the BRTO group, 76% and 55% in the PTO group, and 88% and 63% in the DBOE group, respectively. Conclusion: These three interventional treatments are safe and effective for patients with GV and hepatic encephalopathy.