Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension.
OBJECTIVE
Balloon-occluded retrograde transvenous obliteration (B-RTO) is a novel therapeutic method for the treatment of large gastric fundal varices with spontaneous splenorenal shunt (SRS). However, the effects of B-RTO on liver function remain unknown.


METHODS
Fourteen patients with portal hypertension and gastric varices with SRS were studied, consisting of four patients with acute bleeding, five with high-risk varices, and five with refractory portosystemic encephalopathy. Hepatic venous catheterization was performed to evaluate hepatic blood flow and liver function using the continuous indocyanine green (ICG) infusion method. To assess the metabolic activity of the hepatocyte, the intrinsic clearance of ICG was calculated. In all patients, endoscopic study was performed before and 1 week and 1 month after the B-RTO, and followed every 6 months thereafter. After baseline measurements, B-RTO was performed. Four weeks after the B-RTO, the same catheter measurements were repeated.


RESULTS
The B-RTO was successful in all patients. Contrast-enhanced computed tomography showed complete obliteration of the SRS prior to the follow-up measurements. Endoscopic eradication of the fundal varices was obtained 6 months after B-RTO in all patients and encephalopathy was improved within 1 week after B-RTO. Following the B-RTO, hepatic blood flow (441 +/- 214 vs 668 +/- 299 mL/min, P < 0.0001) and the intrinsic clearance of ICG (233 +/- 123 vs 285 +/- 148 mL/min, P < 0.05) were significantly increased. Furthermore, intrahepatic resistance decreased after the B-RTO (P < 0.005).


CONCLUSIONS
From short-term assessment, B-RTO increases hepatic blood flow and improves the metabolic activity of the liver in patients with portal hypertension.
Miyamoto
Yasunao
Y
Department of Medicine II, Division of Gastroenterology and Endoscopy, Kurume University School of Medicine, Kurume, Japan. yasunao-miya@mtf.biglobe.ne.jp
Oho
Kazuhiko
K
Kumamoto
Masafumi
M
Toyonaga
Atsushi
A
Sata
Michio
M
D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000628:therapy*; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D007208:Indocyanine Green