Emergency balloon-occluded retrograde transvenous obliteration for gastric varices.
BACKGROUND
We evaluated the efficacy of emergency balloon-occluded retrograde transvenous obliteration (B-RTO) performed within 24 h after initial hemostasis for the prevention of rebleeding from ruptured gastric varices.


METHODS
From December 1995 to March 2003, 11 patients who had undergone B-RTO within 24 h after the control of gastric variceal bleeding at Maebashi Red Cross Hospital were investigated. They were followed up for complete eradication, recurrence of varices, and rebleeding. Efficacy was determined by endoscopic examination and computed tomography.


RESULTS
The 4 patients with acute bleeding from ruptured gastric varices were treated with endoscopic therapy-endoscopic variceal ligation (EVL) in 2 patients, and clipping treatment in 2. Initial hemostasis was achieved in all 4; the other 7 patients had already stopped bleeding at endoscopy. After hemostasis was achieved, emergency B-RTO was immediately performed within 24 h and was successful in all 11 patients. Ten (90.9%) of the 11 gastric varices were obliterated and the other 1 (9.1%) was diminished in size. During the mean follow-up period of 1136 days, no rebleeding or recurrence as found. Four patients died during the follow-up period, but none died from variceal bleeding. Survival rates were 90.9% and 70.7%, respectively, at 1 year and 3 years. In 6 patients, development of esophageal varices appeared during the follow-up period, all of which were controlled by usual endoscopic therapy. No severe side effects were found after the B-RTO treatment.


CONCLUSIONS
Emergency B-RTO is an effective treatment for the prevention of rebleeding from ruptured gastric varices.
Arai
Hirotaka
H
Department of Gastroenterology, Maebashi Red Cross Hospital, 3-20-14 Asahi-cho, and Department of Medicine and Molecular Science, Gunma University School of Medicine, Maebashi, 371-0014, Japan.
Abe
Takehiko
T
Shimoda
Ryuya
R
Takagi
Hitoshi
H
Yamada
Toshihiko
T
Mori
Masatomo
M
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D004638:Emergency Treatment; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged