[Therapeutic efficacy of balloon-occluded retrograde transvenous obliteration in patients with gastric variceal bleeding].
OBJECTIVE
Although balloon-occluded retrograde transvenous obliteration (BRTO) has been used as a new procedure for gastric variceal bleeding due to its feasibility and minimal invasiveness, reports regarding the results of BRTO are not well presented in Korea. Therefore, we analyzed the results of our experience in recent 39 months.


METHODS
Twenty eight patients who received BRTO for primary hemostasis or secondary prevention of gastric variceal bleeding from December 2001 to March 2005 were analyzed retrospectively.


RESULTS
Twenty three men and five women were involved, and the mean age was 53.7+/-9.6 years. Technical and clinical success rates were 89.3% and 85.7%, respectively. Follow-up duration was 17.5+/-12.5 months in 23 patients. Gastric varices disappeared in 78.3% and decreased in 21.7%. Relapses occurred in 4.3% of the patients. Preexisting hepatic encephalopathy improved in all 11 patients. Aggravation of ascites, esophageal varices, portal hypertensive gastropathy were observed in 45.8%, 30.4%, 56.5%, respectively. Increased Child-Pugh score (p < 0.001) and decreased albumin concentration (p = 0.002) were observed 3 days after BRTO, but resolved 7 days later. Increased albumin concentration and decreased Child-Pugh score maintained thereafter. Rebleeding occurred in 3 patients which were caused by esophageal varices. Two-year survival rate was 54.6%. Presence of hepatocellular carcinoma (HCC) (p = 0.001) and Child-Pugh grade (p = 0.033) affected the survival, but HCC was the only independent risk factor (p = 0.010, OR = 15.837) in multivariate analysis.


CONCLUSIONS
BRTO is an effective therapeutic procedure for primary hemostasis, secondary prevention, and for improving survival in gastric variceal bleeding patients.
Park
Kyung Sik
KS
Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
Kim
Young Hwan
YH
Choi
Jin Soo
JS
Hwang
Jae Seok
JS
Kwon
Jung Hyeok
JH
Jang
Byoung Kuk
BK
Chung
Woo Jin
WJ
Cho
Kwang Bum
KB
Ko
Sung Min
SM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence