title: Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study.
abstract: OBJECTIVE
  This study evaluated the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC).
  
  
  METHODS
  We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010.
  
  
  RESULTS
  Of the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0±29.2 months (mean±SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047).
  
  
  CONCLUSIONS
  BRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.
authors: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors: Se Young
authors: SY
authors: Jang
authors: Go Heun
authors: GH
authors: Kim
authors: Soo Young
authors: SY
authors: Park
authors: Chang Min
authors: CM
authors: Cho
authors: Won Young
authors: WY
authors: Tak
authors: Jeong Han
authors: JH
authors: Kim
authors: Won Hyeok
authors: WH
authors: Choe
authors: So Young
authors: SY
authors: Kwon
authors: Jae Myeong
authors: JM
authors: Lee
authors: Sang Gyune
authors: SG
authors: Kim
authors: Dae Yong
authors: DY
authors: Kim
authors: Young Seok
authors: YS
authors: Kim
authors: Se-Ok
authors: SO
authors: Lee
authors: Yang Won
authors: YW
authors: Min
authors: Joon Hyeok
authors: JH
authors: Lee
authors: Seung Woon
authors: SW
authors: Paik
authors: Byung Chul
authors: BC
authors: Yoo
authors: Jae Wan
authors: JW
authors: Lim
authors: Hong Joo
authors: HJ
authors: Kim
authors: Yong Kyun
authors: YK
authors: Cho
authors: Joo Hyun
authors: JH
authors: Sohn
authors: Jae Yoon
authors: JY
authors: Jeong
authors: Yu Hwa
authors: YH
authors: Lee
authors: Tae Yeob
authors: TY
authors: Kim
authors: Young Oh
authors: YO
authors: Kweon
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D021721:Balloon Occlusion / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000209:etiology; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Balloon-occluded retrograde transvenous obliteration; Esophageal varices; Gastric varices; Liver cirrhosis; Variceal hemorrhage