Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Gastric Varices: A Single-Center Experience in the Middle East

AIMS: This study aims to assess the short- and long-term outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) in managing gastric varices (GV). METHODS: We conducted a retrospective chart review of all patients who underwent BRTO for actively bleeding or at high-hemorrhagic-risk GV secondary to liver cirrhosis at our facility from January 2007 to December 2019. Descriptive and analytical statistics were used to evaluate short- and long-term postprocedural outcomes. Univariate and multivariate analyses were used to identify significant factors associated with mortality. Survival was assessed using the Kaplan-Meier method. A p-value of <0.05 was considered statistically significant. RESULTS: A total of 35 patients (mean age: 53.3 ± 9.9 years) were included, with the majority being men (N = 29, 82.9%). Most patients had Child-Pugh classification A (N = 14, 40%) or B (N = 13, 37.1%). Twenty-two patients (62.9%) underwent BRTO emergently, and 13 (37.1%) underwent the procedure prophylactically. Collateral embolization and hemostasis were achieved in all but one patient. Gastric variceal recurrence occurred in five patients (14%), and esophageal varices (EV) worsened in three (9%). During a mean follow-up of 96.2 ± 9 months, seven patients (20%) experienced variceal bleeding episodes, all managed endoscopically. The estimated post-BRTO survival rates at 1, 3, 5, and 10 years were 82.1%, 82.1%, 76.6%, and 68.1%, respectively. Preprocedural Child-Pugh classification A or B and total bilirubin levels < 3.5 mg/dL were associated with better survival rates. CONCLUSION: BRTO is a safe and effective treatment for both emergent bleeding control and prophylactic management of high-hemorrhagic-risk GV.