The short-term effects of balloon-occluded retrograde transvenous obliteration, for treating gastric variceal bleeding, on portal hypertensive changes: a CT evaluation.
OBJECTIVE
We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans.


METHODS
We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test.


RESULTS
Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm(3) to 580.8 cm(3), and based on a 15% volume change cut-off value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively)


CONCLUSIONS
Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO.
Cho
Sung Ki
SK
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Shin
Sung Wook
SW
Yoo
Eun Young
EY
Do
Young Soo
YS
Park
Kwang Bo
KB
Choo
Sung Wook
SW
Han
Heon
H
Choo
In Wook
IW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000175:diagnosis / Q000209:etiology; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D002765:Cholecystography; D003287:Contrast Media / Q000008:administration & dosage; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D007422:Intestines / Q000000981:diagnostic imaging; D007472:Iohexol / Q000031:analogs & derivatives; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009929:Organ Size; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging; D013163:Splenomegaly / Q000175:diagnosis / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide