Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome.
OBJECTIVE
It is well known that a large portosystemic shunt develops during portal hypertension. In this study, we studied the long-term effects of a large splenorenal shunt (SRS) on liver function and survival.


METHODS
The subjects were divided into three groups: an SRS (-) group consisting of cirrhotic patients without SRS; an SRS (+) group consisting of patients with gastric fundal varices and SRS; and a balloon-occluded retrograde transvenous obliteration (B-RTO) group with a completely obliterated SRS by B-RTO. We compared the following among these groups: the total bilirubin levels, serum albumin levels, prothrombin times, changes in Child-Pugh scores, and survival rates.


RESULTS
After a 3-year follow-up period the Child-Pugh scores showed significant differences among the SRS (+), SRS (-), and B-RTO groups. The score worsened for the SRS (+) group. The cumulative survival rates were significantly different between the SRS (+) and SRS (-) groups and between the SRS (+) and B-RTO groups. The vital prognosis worsened for the SRS (+) group.


CONCLUSIONS
The presence of a large splenorenal shunt (portosystemic shunt) was indicated to lower liver function and vital prognosis. B-RTO, which completely obliterates large splenorenal shunts, inhibited the lowering of hepatic functional reserve and the worsening of vital prognosis, indicating a protective role. Liver pathology and the presence of a large portosystemic shunt each separately result in progressive liver dysfunction and worsen the survival rate. We found that such a pathological condition had occurred due to a large portosystemic shunt, and it should be called 'portosystemic shunt syndrome.'
Kumamoto
Masafumi
M
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan. varix@med.kurume-u.ac.jp
Toyonaga
Atsushi
A
Inoue
Hiroto
H
Miyakoda
Kenji
K
Morita
Yukihiko
Y
Emori
Keigo
K
Sakamoto
Yoshihiro
Y
Oho
Kazuhiko
K
Sata
Michio
M
D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D001706:Biopsy; D002406:Catheterization, Peripheral / Q000379:methods; D002423:Cause of Death / Q000639:trends; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005748:Gastric Fundus / Q000098:blood supply*; D006501:Hepatic Encephalopathy / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome