Short-term rebleeding rates for isolated gastric varices managed by transjugular intrahepatic portosystemic shunt versus balloon-occluded retrograde transvenous obliteration.
OBJECTIVE
To assess the short-term rebleeding rate associated with the use of a transjugular intrahepatic portosystemic shunt (TIPS) compared with balloon-occluded retrograde transvenous obliteration (BRTO) for management of gastric varices (GV).


METHODS
A single-center retrospective comparison of 50 patients with bleeding from GV treated with a TIPS or BRTO was performed. Of 50 patients, 27 (17 men and 10 women; median age, 55 y; range, 31-79 y) received a TIPS with covered stents, and 23 (12 men and 11 women; median age, 52 y; range, 23-83 y) underwent a BRTO procedure with a foam sclerosant. All study subjects had clinical and endoscopic evidence of isolated bleeding GV and were hemodynamically stable at the time of the procedure. Clinical and endoscopic follow-up was performed. Kaplan-Meier analysis was used to evaluate rebleeding rates from the GV.


RESULTS
The technical success rate was 100% in the TIPS group and 91% in the BRTO group (P = .21). Major complications occurred in 4% of the patients receiving TIPS and 9% of patients the undergoing BRTO (P = .344). Encephalopathy was reported in 4 of 27 (15%) patients in the TIPS group and in none of the patients in the BRTO group (0%; P = .12). At 12 months, the incidence of rebleeding from a GV source was 11% in the TIPS group and 0% in the BRTO group (P = .25).


CONCLUSIONS
BRTO appears to be equivalent to TIPS in the short-term for management of bleeding GV. Further comparative studies are warranted to determine optimal management strategies in individual patients.
Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908. Electronic address: Ss2bp@virginia.edu.
Saher S
SS
Sabri
Department of Diagnostic Radiology, National Institutes of Health, Bethesda, Maryland.
Nadine
N
Abi-Jaoudeh
South Florida Vascular Associates, Coconut Creek, Florida.
Warren
W
Swee
Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908.
Wael E
WE
Saad
Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908.
Ulku C
UC
Turba
Department of Radiology and Medical Imaging, and Division of Gastroenterology, Department of Medicine, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908.
Stephen H
SH
Caldwell
Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908.
John F
JF
Angle
Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908.
Alan H
AH
Matsumoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult