title: Balloon-occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: A meta-analysis.
abstract: OBJECTIVE
  The aim of this study was to compare the feasibility and safety of both balloon-occluded retrograde transvenous obliteration (BRTO) versus transjugular intrahepatic portosystemic shunt (TIPS) for treatment of gastric varices due to portal hypertension through the method of meta-analysis.
  
  
  METHODS
  PubMed, Embase, and Cochrane Library were searched for both randomized controlled trials and cohort studies concerning BRTO compared with TIPS in the treatment of gastric varices from their inception to April 26, 2015. The Cochrane network RevMan 5.3 software was used for statistic analysis. The primary markers that need to be evaluated contained technical success rate, hemostasis rate, incidence rate of postoperative rebleeding, incidence rate of hepatic encephalopathy, and postoperative procedure-related complication. Study-specific odds ratios (ORs) were combined to calculate pooled value by using random effects model.
  
  
  RESULTS
  Five original studies were included in total. Meta-analysis showed that BRTO and TIPS had no difference in aspects of technical success rate (OR, 0.19; 95% confidence interval [CI], 0.03-1.08; P = 0.06), hemostasis rate (OR, 3.41; 95% CI, 0.33-35.40; P = 0.30), and incidence rate of postoperative procedure-related complication (OR, 1.98; 95% CI, 0.44-8.84; P = 0.37). However, BRTO had a lower incidence rate of post-operative rebleeding (OR, 0.27; 95% CI, 0.09-0.81; P = 0.02) and a lower incidence rate of postoperative encephalopathy (OR, 0.05; 95% CI, 0.02-0.13; P < 0.00001).
  
  
  CONCLUSIONS
  Balloon-occluded retrograde transvenous obliteration was a technically feasible as well as a secure method for the treatment of gastric varices originated from portal hypertension. It may have the potential to be an alterative shunt approach of TIPS, when suitable patients selected.
authors.affiliation: Graduate School, Chongqing Medical University, Chongqing, China.|Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yun-Bing
authors.initials: YB
authors.lastname: Wang
authors.affiliation: Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Jian-Ying
authors.initials: JY
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Gong
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D021721:Balloon Occlusion / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000628:therapy*; D005240:Feasibility Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D016896:Treatment Outcome
keywords: balloon-occluded retrograde transvenous obliteration; esophageal and gastric varices; meta-analysis; portal hypertension; transjugular intrahepatic portasystemic shunt