Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices with Gastrorenal Shunt: Long-Term Follow-Up in 78 Patients
- 1 April 2005
- journal article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 184 (4), 1340-1346
- https://doi.org/10.2214/ajr.184.4.01841340
Abstract
OBJECTIVE. Our aim was to evaluate the long-term clinical results after balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices with spontaneous gastrorenal shunt. MATERIALS AND METHODS. A total of 78 patients with cirrhosis and with gastric varices, successfully treated by B-RTO, were enrolled in this study. Recurrence and bleeding of gastric varices and worsening of esophageal varices were endoscopically evaluated. Univariate and multivariate analyses were used to assess the prognostic factors for worsening of esophageal varices and survival. RESULTS. Recurrence of gastric varices was found in two patients; the 5-year recurrence rate was 2.7%. Bleeding of gastric varices occurred in only one patient after B-RTO; the 5-year bleeding rate was 1.5%. Worsening of esophageal varices was observed in 29 patients, and the worsening rates at 1, 3, and 5 years were 27%, 58%, and 66%, respectively. These esophageal varices were endoscopically treated to prevent rupture. Multivariate analysis showed the presence of esophageal varices before B-RTO was a prognostic factor for worsening (relative risk, 4.956). At a median follow-up of 700 days (range, 137-2,339 days), the survival rates at 1, 3, and 5 years were 93%, 76%, and 54%, respectively. The prognostic factors associated with survival were presence of hepatocellular carcinoma (relative risk, 24.342) and the Child-Pugh classification (relative risk, 5.780). CONCLUSION. B-RTO is an effective method for gastric varices with gastrorenal shunt and provides lower recurrence and bleeding rates. We believe that B-RTO can become a standard treatment for gastric varices with gastrorenal shunt, although treatment of worsened esophageal varices may be necessary after B-RTO.Keywords
This publication has 29 references indexed in Scilit:
- Retrograde Transvenous Obliteration of Gastric VaricesRadiology, 1999
- Balloon-Occluded Retrograde Transvenous Obliteration of High Risk Gastric Fundal VaricesThe American Journal of Gastroenterology, 1999
- Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals.American Journal of Roentgenology, 1996
- Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patientsHepatology, 1992
- Portal hemodynamics in patients with gastric varicesGastroenterology, 1988
- Endoscopic sclerotherapy in the treatment of gastric varicesBritish Journal of Surgery, 1988
- Endoscopic injection sclerosis in bleeding gastric varicesGastrointestinal Endoscopy, 1986
- Emergency endoscopic sclerotherapy for bleeding esophageal varices: a prospective study in patients not responding to balloon tamponadeGastrointestinal Endoscopy, 1983
- Prediction of variceal hemorrhage by esophageal endoscopyGastrointestinal Endoscopy, 1981
- Sclerotherapy of Bleeding Oesophageal Varices by Means of EndoscopyEndoscopy, 1978