title: Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  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 METHDOS: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Seoul City Boramae Hospital, Seoul, Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Choi
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Yoon
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Kwon
authors.forename: Guk Myung
authors.initials: GM
authors.lastname: Choi
mesh_terms: D021721:Balloon Occlusion; D016022:Case-Control Studies; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed