title: Impact of balloon-occluded retrograde transvenous obliteration on management of isolated fundal gastric variceal bleeding.
abstract: OBJECTIVE
  Although endoscopic injection of cyanoacrylate (CA) is the only effective method for treating isolated fundal gastric variceal bleeding, the rebleeding rate is relatively high. This study investigated the efficacy of balloon-occluded retrograde transvenous obliteration (B-RTO) for management of isolated fundal gastric variceal bleeding.
  
  
  METHODS
  Patients (n = 110) with acute or recent bleeding from isolated fundal gastric varices (GV) were retrospectively studied. Acute bleeding was treated by CA injection or balloon tamponade. 44 patients underwent additional endoscopic injection of CA and ethanolamine oleate (EO) weekly until obturation of GVx from 1994 to 2002 (group A). 42 patients from 2003 to 2010 underwent B-RTO after initial hemostasis (group B). Both groups were assessed for the number of sessions required to achieve GV obturation, hospital stay, recurrent bleeding rate, morbidity and mortality.
  
  
  RESULTS
  Acute gastric variceal bleeding was successfully treated in all patients by CA injection or balloon tamponade. B-RTO was successfully performed except in two patients in group B. The average number of sessions required for obturation was 3.8 for groups A and 2.2 for B (P < 0.05). Recurrent bleeding was observed in 16 and two patients in groups A and B, respectively. The cumulative non-rebleeding rate at 5 years was 58.3% and 98.1% in groups A and B, respectively. The cumulative survival rate at 5 years was 53.8% and 87.6% in groups A and B, respectively.
  
  
  CONCLUSIONS
  Balloon-occluded retrograde transvenous obliteration may be superior to endoscopic injection with CA and EO for prevention of rebleeding in patients with isolated fundal GVs with a major shunt.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences             Center of Integration of Advanced Medicine, Life Science and Innovative Technology, Kyushu University, Fukuoka, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Masao
authors.initials: M
authors.lastname: Kamori
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsutsumi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nagao
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara