The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration.
BACKGROUND
The purpose of our study was to evaluate the long-term outcome and complications of balloon-occluded retrograde transvenous obliteration (B-RTO) in patients with hemorrhage from gastric fundal varices.


METHODS
Thirty-four consecutive patients with bleeding from gastric varices who were treated with B-RTO were enrolled in this study between December 1994 and September 2005 (urgent cases, n = 12; elective cases, n = 22). The long-term outcome, complications, and various liver functions were evaluated.


RESULTS
Complete obliteration was achieved in 31 of 34 (91%) patients with an acute bleeding episode. In one of the remaining patients, there was a technical failure, and the other two had only partial obliteration. The two patients with partial obliteration did not obtain hemostasis. Thus, the rate of hemostasis was 94% (31/33). Gastric varices disappeared in all patients with complete obliteration during the treatment. The rate of gastric variceal eradication was 91%. Variceal rebleeding from esophageal varices occurred in three patients. The rate of rebleeding was 10% (3/31). Rebleeding from gastric varices was not observed after complete obliteration. None of the patients showed worsening of their Child-Pugh score. Although the 5-year cumulative worsening rate of esophageal varices was 52%, neither portal hypertensive gastropathy nor ectopic varices were observed. The patients with worsening esophageal varices were successfully treated with an endoscopic procedure. The 5-year survival rate was 68%.


CONCLUSIONS
B-RTO is useful for treatment of bleeding gastric varices, achieving high eradication of gastric varices, a low rebleeding rate, and a fairly good prognosis with improved hepatic function.
Hiraga
Nobuhiko
N
Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Aikata
Hiroshi
H
Takaki
Shintaro
S
Kodama
Hideaki
H
Shirakawa
Hiroo
H
Imamura
Michio
M
Kawakami
Yoshiiku
Y
Takahashi
Shoichi
S
Toyota
Naoyuki
N
Ito
Katsuhide
K
Tanaka
Shinji
S
Kitamoto
Mikiya
M
Chayama
Kazuaki
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
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