Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience.
OBJECTIVE
Balloon-occluded retrograde transvenous obliteration (B-RTO) is a new alternative treatment for gastric varices (GVx), but the long-term efficacy is not known. We investigated the long-term effects of B-RTO on rebleeding, prevention of first bleeding, mortality and occurrence of risky esophageal varices (EVx).


METHODS
B-RTO was performed in 68 cirrhotic patients with GVx. Twenty patients had recent bleeding, transiently treated by endoscopic Histoacryl injection or balloon tamponade. Forty-eight patients had varices likely to bleed, but no bleeding. After B-RTO, the recurrent bleeding, occurrence of EVx and mortality over the long-term were evaluated.


RESULTS
B-RTO was successfully performed in 63 of 68 patients (92.6%). Varices eradication was confirmed by endoscopy in 61 of 63 patients (96.6%). During follow up, GVx bleeding occurred in two patients (3.2%). The 8-year cumulative rebleeding rates of patients with bleeding and risky GVx were 14% and 0%, respectively. Risky EVx occurred in 10 patients (17%) and the cumulative occurrence rate was 22% in 8 years. The cumulative occurrence rate of risky EVx was higher in GVx with EVx (GOV2-GVx) compared to GVx without EVx (IGV1, P < 0.05). No ectopic variceal bleeding occurred. No patients died from variceal bleeding. Hepatocellular carcinoma was the only significant prognostic factor (P < 0.05).


CONCLUSIONS
B-RTO is beneficial over the long-term, despite worsening EVx in some patients, because of excellent treatment efficacy and improved mortality. We believe that B-RTO can become a first-choice radical treatment following hemostasis for gastric variceal bleeding and prophylactic treatment for risky GVx.
Akahoshi
Tomohiko
T
Departments of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. a_tom411@yahoo.co.jp
Hashizume
Makoto
M
Tomikawa
Morimasa
M
Kawanaka
Hirofumi
H
Yamaguchi
Shohei
S
Konishi
Kouzo
K
Kinjo
Nao
N
Maehara
Yoshihiko
Y
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects; D004659:Enbucrilate / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005773:Gastroscopy; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000627:therapeutic use; D010690:Phlebography; D012008:Recurrence; D018570:Risk Assessment; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000009:adverse effects; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
D009829:Oleic Acids; D012597:Sclerosing Solutions; D014014:Tissue Adhesives; D004659:Enbucrilate; C033343:ethanolamine oleate