title: Predictive factors of worsening of esophageal varices after balloon-occluded retrograde transvenous obliteration in patients with gastric varices.
abstract: OBJECTIVE
  Although balloon-occluded retrograde transvenous obliteration (B-RTO) is useful for management of gastric varices, worsening of esophageal varices (EV) is the most important complication of B-RTO. The predictive factors of worsening of EV have not been evaluated in detail. This study was designed to evaluate the role of endoscopic color Doppler ultrasonography (ECDUS) in the detection of possible risk factors for worsening of EV after B-RTO.
  
  
  METHODS
  A total of 39 cirrhotic patients with high-risk gastric varices successfully treated by B-RTO were included in this study. All patients underwent ECDUS before B-RTO to measure hemodynamic parameters of gastric varices and regular endoscopic follow-up after B-RTO to detect worsening of EV. The risk factors were analyzed by Cox's proportional hazards regression.
  
  
  RESULTS
  Worsening of EV was found in 24 (61.5%) patients. The presence of esophageal varices before B-RTO and a lower degree of liver dysfunction (Child-Pugh class B) were statistically independent risk factors for worsening of EV after B-RTO (hazard ratio, HR, 5.81, 95% confidence interval, CI, 1.71-19.77 and HR 2.92, 95% CI: 1.21-7, respectively). High resistance index (> or =0.24), measured by ECDUS, is also an independent risk factor for worsening of EV after B-RTO (HR 4.06, 95% CI: 1.14-14.38) and increase in resistance index is associated with worsening of EV (P for trend=0.028).
  
  
  CONCLUSIONS
  The presence of EV, higher Child-Pugh class, and higher resistance index assessed by ECDUS before B-RTO were significant risk factors for worsening of EV after B-RTO.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Mahmoud K
authors.initials: MK
authors.lastname: Elsamman
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Kameda
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Okazaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Shiba
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Oshitani
authors.forename: Usama A
authors.initials: UA
authors.lastname: Arafa
authors.forename: Adel A
authors.initials: AA
authors.lastname: El-Sayed
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa