title: Long-term follow up of esophageal varices after balloon-occluded retrograde transvenous obliteration for gastric varices.
abstract: OBJECTIVE
  Because the procedure of balloon-occluded retrograde transvenous obliteration (B-RTO) causes extensive thrombosis of the major shunt that connects the spleen and gastric/renal venous systems, an increase in portal pressure is unavoidable. The aim of the present study was to assess the long-term outcome of B-RTO, including changes in esophageal varices.
  
  
  METHODS
  B-RTO was conducted in 22 patients with gastric varices, who were divided according to the severity of esophageal varices at baseline; there were no esophageal varices (n = 7), F(1) varices (n = 11), and F(2) varices (n = 4). The outcome measures included the development/worsening of esophageal varices after B-RTO and survival rates.
  
  
  RESULTS
  The cumulative bleeding-free probability for all 22 patients at 3 years after B-RTO was 100%. The overall 3-year survival was 94.4%. Seven patients who had no esophageal varices prior to B-RTO did not develop any after the procedure. Seven (63.6%) of the 11 patients with stage F(1) esophageal varices prior to B-RTO showed no changes in the varices after B-RTO, while two patients progressed to F(2) varices and two developed F(3) varices. The cumulative treatment-free probability of the esophageal varices at 24 months after B-RTO was 100% for patients without esophageal varices at baseline, 80.8% for patients with pre-existing F(1) varices, and 75% for those with pre-existing F(2) varices.
  
  
  CONCLUSIONS
  Although the B-RTO procedure is considered useful for the treatment of gastric varices, changes in hemodynamics due to obliteration of this major shunt must be taken into account and observed closely.
authors.affiliation: Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakamura
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Torii
authors.forename: Satoru
authors.initials: S
authors.lastname: Yatsuji
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konishi
authors.forename: Maiko
authors.initials: M
authors.lastname: Kishino
authors.forename: Makiko
authors.initials: M
authors.lastname: Taniai
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Tokushige
authors.forename: Etsuko
authors.initials: E
authors.lastname: Hashimoto
authors.forename: Keiko
authors.initials: K
authors.lastname: Shiratori