title: Usefulness of balloon-occluded retrograde transvenous obliteration for gastric varices concurrent with hepatocellular carcinoma.
abstract: OBJECTIVE
  We performed balloon-occluded retrograde transvenous obliteration (B-RTO) before hepatocellular carcinoma (HCC) therapy in cases with HCC and gastric varices (GV) containing porto-systemic shunts. We conducted retrospective analyses on effects of B-RTO on hepatic functional reserve and HCC, as well as associated complications, and verified HCC treatment timing.
  
  
  METHODS
  B-RTO was performed before HCC therapy after confirming disappearance or shrinkage of gastro-renal shunt with 3-dimensional computed tomography (3D-CT). Hepatic resection (HR) was performed in 7 of 12 cases, and transcatheter chemo-embolization (TACE) was used in 5 cases.
  
  
  RESULTS
  B-RTO significantly improved GV (P=0.002). Improvement in grade/form was observed by endoscopy after 84.1 days, and that in gastro-renal shunt was observed by 3D-CT after 13.9 days. HCC size (P=0.862) and stage didn't change after B-RTO. Two cases showed improved Child-Pugh classification, and no deterioration in hepatic functional reserve was observed. B-RTO was performed 37.9 days before HCC therapy in surgical cases, and 45 days in TACE cases.
  
  
  CONCLUSIONS
  Performing B-RTO before HCC therapy did not exacerbate HCC and allowed its safe performance. Evaluation with 3D-CT after B-RTO to determine HCC therapy timing was possible after 2 weeks. However, care is needed as esophageal varices worsened in some cases.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Akinori
authors.initials: A
authors.lastname: Tamura
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ishii
authors.forename: Shoichi
authors.initials: S
authors.lastname: Miyazawa
authors.forename: Taku
authors.initials: T
authors.lastname: Mizutani
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ito
authors.forename: Shinya
authors.initials: S
authors.lastname: Kamimura
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Kazusige
authors.initials: K
authors.lastname: Nirei
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamagami
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Moriyama
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged