Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleeding: Its Feasibility Compared with Transjugular Intrahepatic Portosystemic Shunt

Its Feasibility Compared with Transjugular Intrahepatic Portosystemic ShuntObjective: To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods:Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention.In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS.Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO.All patients were followed up for 6 to 21 (mean, 14.4) months.For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used.Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test.Results: One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis.Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS.Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred.In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05).In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02).Conclusion: BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.he prevalence of gastric varices in patients with portal hypertension is approximately 30% (1 3), lower than that of esophageal varices.The frequency with which gastric varices bleed is 3 30% (4 8), and because of the greater and faster blood flow -and in spite of various treatment modalities -the rupture of gastric varices results in a higher mortality rate (45 55%) than in cases in which esophageal varices rupture (4, 8 10).Shunt surgery, endoscopic injection sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) have been used for gastric varices.Shunt surgery, however, is invasive, and patients with poor hepatic functional reserve are contraindicated for surgery (11,12).Endoscopic injection sclerotherapy is usually ineffective for varices located in the gastric cardia and fundus: an easy endoscopic approach is not possible,