title: Factors associated with aggravation of esophageal varices after B-RTO for gastric varices.
abstract: OBJECTIVE
  To retrospectively evaluate risk factors for aggravation of esophageal varices (EV) within 1 year after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices (GV) and to clarify suitable timing for upper endoscopy to detect EV aggravation after B-RTO.
  
  
  METHODS
  Participants included 67 patients who underwent B-RTO for GV between January 2006 and December 2010. Whether EV aggravation occurred within 1 year was evaluated, and the time interval from B-RTO to aggravation was calculated. Factors potentially associated with EV aggravation were analyzed.
  
  
  RESULTS
  B-RTO was successfully performed in all patients. EV aggravation at 1 year after B-RTO was found in 38 patients (56.7 %). Multivariate logistic regression analysis showed that total bilirubin (T-bil) (P = 0.032) and hepatic venous pressure gradient (HVPG) (P = 0.011) were significant independent risk factors for EV aggravation after B-RTO. Cutoff values of T-bil and HVPG yielding maximal combined sensitivity and specificity for EV aggravation were 1.6 mg/dL and 13 mmHg, respectively. The patients with T-bil ≥ 1.6 mg/dL or HVPG ≥ 13 mmHg had a median aggravation time of 5.1 months. All five patients with ruptured EV belonged to this group. In contrast, patients with T-bil < 1.6 mg/dL and HVPG < 13 mmHg had a median aggravation time of 21 months.
  
  
  CONCLUSIONS
  T-bil and HVPG were significant independent risk factors for EV aggravation after B-RTO. The patients with T-bil ≥ 1.6 mg/dL or HVPG ≥ 13 mmHg require careful follow-up evaluation, including endoscopy.
authors: Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan, duexg204@gmail.com.
authors: Atsushi
authors: A
authors: Jogo
authors: Norifumi
authors: N
authors: Nishida
authors: Akira
authors: A
authors: Yamamoto
authors: Hiroto
authors: H
authors: Matsui
authors: Tohru
authors: T
authors: Takeshita
authors: Yukimasa
authors: Y
authors: Sakai
authors: Toshiyuki
authors: T
authors: Matsuoka
authors: Kenji
authors: K
authors: Nakamura
authors: Yukio
authors: Y
authors: Miki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D001663:Bilirubin / Q000097:blood; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D014690:Venous Pressure / Q000502:physiology
chemical_list: D001663:Bilirubin