Abstract
Objectives:In this study, we propose a modified balloon-occluded retrograde transvenous obliteration (BRTO) strategy – balloon-assisted antegrade transvenous obliteration (BAATO), and explore the feasibility, efficacy and safety of BAATO combined with transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cardiofundal varices (GOV2 or IGV1) hemorrhage.Materials and methods:In this retrospective cohort study, 15 patients with cardiofundal varices hemorrhage who received BAATO combined with TIPS procedures, from August 2017 to September 2019 in our center, were enrolled. They consisted of seven patients with GOV2 and eight patients with IGV1. The clinical efficacy and safety of BAATO + TIPS procedures were assessed by comparing the clinical symptoms, laboratory and imaging examinations before and after treatment.Results:The technical success rate of BAATO + TIPS procedure was 100%. After the procedure, clinical symptoms were improved and complete regression of gastric varices (GVs) was observed in all patients, besides, the control efficiency of ascites and PVT which were 77.8 and 87.5%, respectively. No patient died or had a rebleeding during the follow up, but grade II hepatic encephalopathy (HE) occurred in two patients (13.3%) and shunt dysfunction was discovered in one patient (6.7%).Conclusion:For the treatment of GVs, the new technique BAATO is feasible, safe and effective, and it may be a more convenient and economical method than conventional BRTO. In addition, the combination of BAATO and TIPS may play a positive role in achieving hemostasis and improving the complications of portal hypertension such as ascites and PVT.
Highlights
Gastric varices (GVs) are present in around 20% of patients with portal hypertension [1]
According to Sarin’s classification [2], GV is divided into four types including gastroesophageal varices type 1 (GOV1), GOV type 2 (GOV2), isolated GV type 1 (IGV1) and isolated GV type 2 (IGV2), among which GOV2 and IGV1 are commonly referred to European Journal of Gastroenterology & Hepatology 2020, 32:656–662
The inclusion criteria were as follows: (1) Upper gastrointestinal bleeding, (2) cardiofundal varices confirmed by endoscopic examination, (3) contrast-enhanced computed tomography (CT) of the portal system revealed the presence of gastrorenal shunt (GRS), (4) treatment with balloon-assisted antegrade transvenous obliteration (BAATO) + transjugular intrahepatic portosystemic shunt (TIPS) procedures
Summary
Gastric varices (GVs) are present in around 20% of patients with portal hypertension [1]. Received 2 December 2019 Accepted 20 January 2020. BRTO technique was first developed and named by Kanagawa et al [5]. During this procedure, the occlusion balloon catheter is advanced into the GVs through gastrorenal shunt (GRS), and sclerosant was injected into GVs with the occlusion of GRS [6,7]. The occlusion balloon catheter should be placed for 5 h or longer under balloon occlusion in order to maximize the residence time of sclerosant in GVs and minimize the occurrence of complications [9,10]
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