title: Risk factors for rebleeding and prognostic factors for postoperative survival in patients with balloon-occluded retrograde transvenous obliteration of acute gastric variceal rupture.
abstract: OBJECTIVE
  Balloon-occluded retrograde transvenous obliteration (B-RTO) has shown great potential in controlling acute gastric variceal hemorrhage, although rebleeding related to the procedure may occur in a small percentage of patients. The purpose of this study was to identify risk factors of perioperative rebleeding and prognostic factors of postoperative survival in B-RTO performed for acute episodes of gastric variceal hemorrhage.
  
  
  METHODS
  We retrospectively analyzed 39 consecutive patients who underwent B-RTO for gastric variceal rupture at our hospital between June 2003 and May 2011. Uni- and multi-variate analyses were performed to assess risk factors for perioperative rebleeding and prognostic factors for postoperative survival.
  
  
  RESULTS
  Surgical success and complete eradication of varices were achieved in 36 cases (92.3 %) and 35 cases (89.7 %), respectively. Six patients experienced rebleeding either intraoperatively (n = 3) or within 1 h after B-RTO (n = 3). Child-Pugh class C was identified as a risk factor for rebleeding on univariate (P = 0.018) and multivariate analyses (odds ratio, 6.003; P = 0.014). With a median follow-up of 23 months (range 0-106.6 months), overall survival rates at 1, 3, and 5 years were 91.7, 74.7, and 67.2 %, respectively. Multivariate analyses revealed Child-Pugh class C as a prognostic factor for survival (relative risk, 4.014; P = 0.023).
  
  
  CONCLUSIONS
  Although B-RTO is generally effective in the treatment of acute gastric variceal rupture, patients classified as Child-Pugh class C have a higher risk of perioperative rebleeding and shorter survival.
authors.affiliation: Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan, kageyamaken0112@gmail.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Kageyama
authors.forename: Norifumi
authors.initials: N
authors.lastname: Nishida
authors.forename: Akira
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Jogo
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hamamoto
authors.forename: Hiroto
authors.initials: H
authors.lastname: Matsui
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Yukio
authors.initials: Y
authors.lastname: Miki
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000628:therapy; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome