S0986 Outcomes of Balloon-Occluded Retrograde Transvenous Obliteration and Its Variants for Treatment of Gastric Varices at a High-Volume North American Center

Abstract

INTRODUCTION: BRTO is a common alternative to TIPS or endoscopy for controlling gastric variceal bleeding. Its universal adoption has however been limited due to lack of expertise and fears regarding complications. This study evaluates outcomes of BRTO and its variants, Coil-Assisted Retrograde Transvenous Obliteration (CARTO) and Balloon-Occluded Antegrade Transvenous Obliteration (BATO) at a single center. METHODS: A retrospective review of patients undergoing BRTO or a variant procedure from 6/2013-6/2019 at our institution was performed. Data was collected on demographics, indication, MELD score at time of, 1 month and 1-year post procedure, technical success, complications, rebleed events, mortality, worsening of ascites, encephalopathy, esophageal varices, systemic thrombosis and hepatocellular carcinoma (HCC) incidence up to 1 year post procedure. Statistics were calculated using univariate two-group t-tests or Wilcoxon rank-sum test for continuous variables and non-parametric tests. RESULTS: A total of 65 patients, 11 (16.9%) BATO, 6 (9.2%) BRTO, 45 (69.2%) BRTO/CARTO and 3 (4.6%) BATO/BRTO were evaluated. A 93.8% technical success rate was noted with 2 failures in BATO and 2 in BRTO due to intraprocedural vessel rupture and anatomic issues. High risk gastric varices or bleeding was the most common indication occurring in 53 (81.5%) cases. 1 BATO/BRTO case was complicated by post-procedural sepsis. There were a total of 3 (5%) rebleeding events. 1 BATO patient died from rebleeding on day of procedure and 1 BRTO/CARTO patient died the following day. 4 patients developed new esophageal varices of which 2 bled within one year that was controllable endoscopically. 4 (6.5%) patients developed worsening ascites, 2 (3%) had new or worsened encephalopathy and 9 (13%) developed systemic thrombosis. No patients developed HCC post-procedurally. Mean change in MELD was −0.88 1 month post-procedure with no significant difference in MELD scores from procedure time to 1 month (P = 0.769) or 1 month to 1 year (P = 0.132) when comparing BRTO to its variants. CONCLUSION: Our data demonstrates that BRTO and its variants are effective alternatives to TIPS for treatment of gastric varices without significant adverse effect on MELD scores and minimal to no worsening of portal hypertension related complications. Physicians however must remain vigilant for risk of systemic thromboses and esophageal variceal formation. Of note, previous fears of worsening ascites or increased risk for HCC are not supported by our study.