Long-term follow up of esophageal varices after balloon-occluded retrograde transvenous obliteration for gastric varices.
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.
Nakamura
Shinichi
S
Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Torii
Nobuyuki
N
Yatsuji
Satoru
S
Konishi
Hiroyuki
H
Kishino
Maiko
M
Taniai
Makiko
M
Tokushige
Katsutoshi
K
Hashimoto
Etsuko
E
Shiratori
Keiko
K