title: The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration.
abstract: 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.
authors: 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.
authors: Nobuhiko
authors: N
authors: Hiraga
authors: Hiroshi
authors: H
authors: Aikata
authors: Shintaro
authors: S
authors: Takaki
authors: Hideaki
authors: H
authors: Kodama
authors: Hiroo
authors: H
authors: Shirakawa
authors: Michio
authors: M
authors: Imamura
authors: Yoshiiku
authors: Y
authors: Kawakami
authors: Shoichi
authors: S
authors: Takahashi
authors: Naoyuki
authors: N
authors: Toyota
authors: Katsuhide
authors: K
authors: Ito
authors: Shinji
authors: S
authors: Tanaka
authors: Mikiya
authors: M
authors: Kitamoto
authors: Kazuaki
authors: K
authors: Chayama
mesh_terms: 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
references: Surgery. 2002 Jan;131(1 Suppl):S176-81
references: 11821807
references: Hepatology. 2005 Feb;41(2):386-400
references: 15660434
references: J Vasc Interv Radiol. 2001 Mar;12(3):327-36
references: 11287510
references: Hepatogastroenterology. 1996 May-Jun;43(9):571-4
references: 8799397
references: Taehan Kan Hakhoe Chi. 2003 Dec;9(4):315-23
references: 14695698
references: Gut. 2002 Aug;51(2):270-4
references: 12117893
references: AJR Am J Roentgenol. 2002 May;178(5):1167-74
references: 11959725
references: AJR Am J Roentgenol. 1989 Apr;152(4):755-60
references: 2784259
references: AJR Am J Roentgenol. 2005 Apr;184(4):1340-6
references: 15788621
references: Eur J Gastroenterol Hepatol. 2004 Jan;16(1):9-18
references: 15095847
references: Gut. 2003 May;52(5):772; author reply 772
references: 12692074
references: J Gastroenterol. 2005 Oct;40(10):964-71
references: 16261433
references: Hepatology. 1997 Feb;25(2):307-12
references: 9021939
references: AJR Am J Roentgenol. 2001 Apr;176(4):899-905
references: 11264074
references: Radiographics. 2003 Jul-Aug;23 (4):911-20
references: 12853665
references: Am J Gastroenterol. 1995 Mar;90(3):508-10
references: 7872302
references: Hepatogastroenterology. 2004 Sep-Oct;51(59):1506-9
references: 15362788
references: J Vasc Interv Radiol. 2005 Jan;16(1):113-8
references: 15640418
references: Gastroenterology. 1999 Aug;117(2):515-6
references: 10465641
references: Dig Surg. 2000;17(1):23-8
references: 10720828
references: AJR Am J Roentgenol. 2002 Dec;179(6):1597-603
references: 12438061
references: Gastrointest Endosc. 1986 Aug;32(4):264-8
references: 3488937
references: Hepatology. 1990 Mar;11(3):348-52
references: 2312049
references: J Hepatol. 2003;38 Suppl 1:S54-68
references: 12591186
references: Endoscopy. 1995 Jun;27(5):349-54
references: 7588347
references: Gastroenterology. 1997 Mar;112(3):889-98
references: 9041251
references: Gut. 1985 Nov;26(11):1226-32
references: 3877665
references: J Gastroenterol Hepatol. 1996 Jan;11(1):51-8
references: 8672742
references: Gastroenterology. 2004 Apr;126(4):1175-89
references: 15057756
references: Am J Gastroenterol. 1999 Mar;94(3):643-9
references: 10086645
references: Radiology. 2005 Jul;236(1):360-7
references: 15955858
references: Am J Gastroenterol. 2005 Jan;100(1):43-7
references: 15654779
references: J Hepatol. 2004 Oct;41(4):560-6
references: 15464235
references: Radiology. 1999 May;211(2):349-56
references: 10228513
references: J Gastroenterol Hepatol. 2003 Aug;18(8):934-42
references: 12859723
references: Gut. 2000 Jun;46 Suppl 3-4:III1-III15
references: 10862604
references: Korean J Radiol. 2003 Apr-Jun;4(2):109-16
references: 12845306
references: Hepatology. 1992 Dec;16(6):1343-9
references: 1446890
references: Abdom Imaging. 1996 Jul-Aug;21(4):299-303
references: 8661570
references: N Engl J Med. 1994 Jan 20;330(3):165-71
references: 8264738
references: Am J Gastroenterol. 2001 Dec;96(12):3379-83
references: 11774952
references: World J Surg. 1995 May-Jun;19(3):420-2; discussion 423
references: 7638999
references: Gastroenterology. 2003 May;124(6):1700-10
references: 12761727
references: Gastrointest Endosc. 2002 Oct;56(4):522-8
references: 12297768
references: AJR Am J Roentgenol. 2001 Nov;177(5):1091-3
references: 11641177
references: Hepatogastroenterology. 1998 May-Jun;45(21):677-83
references: 9684116
references: AJR Am J Roentgenol. 2003 Oct;181(4):1011-5
references: 14500220
references: Cardiovasc Intervent Radiol. 1998 Jan-Feb;21(1):27-30
references: 9473542
references: AJR Am J Roentgenol. 1996 Nov;167(5):1317-20
references: 8911204
references: Gastrointest Endosc. 2000 Aug;52(2):160-7
references: 10922085
references: Radiographics. 2003 Jul-Aug;23 (4):921-37; discussion 937
references: 12853666
references: AJR Am J Roentgenol. 2004 Aug;183(2):369-76
references: 15269027
references: Am J Gastroenterol. 1997 Jun;92 (6):1026-30
references: 9177524
references: Surgery. 2001 Apr;129(4):414-20
references: 11283531