[Therapeutic efficacy of balloon-occluded retrograde transvenous obliteration in the treatment of gastric varices in cirrhotic patients with gastrorenal shunt].
OBJECTIVE
Rupture of gastric varices was one of the most dreadful complications of cirrhosis. Recently, a new interventional procedure, balloon-occluded retrograde transvenous obliteration (B-RTO) was introduced for the treatment of gastric variceal bleeding. This study was performed to evaluate the therapeutic efficacy of B-RTO in the treatment of gastric varices with gastro-renal shunts.


METHODS
From March 2000 to June 2003, we performed B-RTO in 17 patients with gastric varices and gastrorenal shunts. All patients had history or high risk factors of gastric variceal bleeding. For the evaluation of therapeutic efficacy, we performed esophagogastroduodenoscopy (EGD) and computed tomography (CT) at 1, 6 and 12 months after B-RTO. Successful B-RTO was judged by combined CT findings and EGD findings (disappearance of gastric varices or markedly reduced gastric variceal size or bleeding risk) during follow-up periods (1-14 months, mean:6.18). We analyzed the clinical factors related to clinical success of B-RTO.


RESULTS
Technical success were achieved in all patients except one (94.1%). Gastric varices were disappeared or decreased after B-RTO in 13 patients (81.2%). Complications related to procedure included transient hematuria (n=5), puncture site oozing (n=1) and partial splenic infarction (n=1), and all were conservatively managed. During the follow up periods, neither significant hepatic nor renal functional damages occurred. Statistically, no significant factors related with B-RTO success.


CONCLUSIONS
B-RTO is effective and safe in the management of gastric varices in cirrhotic patients with gastrorenal shunt.
Baik
Gwang Ho
GH
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Korea.
Kim
Dong Joon
DJ
Lee
Ho Gwon
HG
Min
Seul Ki
SK
Kong
Seung Jin
SJ
Kim
Jin Bong
JB
Lee
Ja Young
JY
Hahn
Tae Ho
TH
Baek
Il Hyun
IH
Kim
Jong Hyeok
JH
Kim
Bong Soo
BS
Hwang
Woo Cheol
WC
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged