title: Simultaneous combined balloon-occluded retrograde transvenous obliteration and partial splenic embolization for portosystemic shunts.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE) for gastric varices and/or hepatic encephalopathy.
  
  
  METHODS
  B-RTO was performed in 19 consecutive patients with gastric varices and/or hepatic encephalopathy, of whom 10 received simultaneous combined B-RTO and PSE (group 1) and nine received B-RTO monotherapy (group 2). To evaluate the safety of these techniques, we analyzed 20 patients who received PSE monotherapy during the same period as a control group (group 3). Outcomes were retrospectively assessed.
  
  
  RESULTS
  No significant differences were observed in baseline characteristics among the three groups except for significantly lower platelet counts and larger spleen volumes in group 3. In all cases in groups 1 and 2, gastric varices disappeared and hepatic encephalopathy improved after treatment. Procedure times were not significantly different between groups 1 and 2 (P = .7435). In group 1, the volume of sclerosing agent required for B-RTO was significantly lower (P = .0355) and exacerbation of esophageal varices was significantly less frequent (P = .0146) than in group 2. Few serious complications occurred in patients who received combined therapy.
  
  
  CONCLUSIONS
  This study indicates that concomitant PSE may help diminish the increase in portal venous pressure after B-RTO for portosystemic shunts, and may allow a reduction in the volume of hazardous sclerosing agent used. It is worth evaluating the efficacy of simultaneous B-RTO and PSE in a prospective study.
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, 467-3 Shumoku, Chuo-ku, Niigata 950-1197, Japan. waguri@hosp.niigata.niigata.jp
authors.forename: Nobuo
authors.initials: N
authors.lastname: Waguri
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yokoo
authors.forename: Rie
authors.initials: R
authors.lastname: Sato
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Arao
authors.forename: Toru
authors.initials: T
authors.lastname: Setsu
authors.forename: Munehiro
authors.initials: M
authors.lastname: Sato
authors.forename: Junji
authors.initials: J
authors.lastname: Kohisa
authors.forename: Isamu
authors.initials: I
authors.lastname: Hama
authors.forename: Kaori
authors.initials: K
authors.lastname: Ohsugi
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Aiba
authors.forename: Osamu
authors.initials: O
authors.lastname: Yoneyama
authors.forename: Koichi
authors.initials: K
authors.lastname: Furukawa
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Sugimura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Igarashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suda
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects / Q000401:mortality; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013157:Splenic Artery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome