title: Simultaneous combined balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices.
abstract: BACKGROUND
  We previously reported the techniques and usefulness of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE), based on the hypothesis that concomitant PSE can diminish the increase in portal venous pressure after B-RTO.
  
  
  OBJECTIVE
  After experiencing more cases and performing longer-term follow-up, we re-evaluated the efficacy of simultaneous combined B-RTO and PSE for gastric fundal varices (GVs).
  
  
  METHODS
  We performed B-RTO in 36 consecutive patients treated for GVs from 2005 to 2013. Twenty-three patients underwent simultaneous combined B-RTO and PSE (Group 1) and 13 underwent B-RTO monotherapy (Group 2). The outcomes were retrospectively evaluated.
  
  
  RESULTS
  There were no significant differences in baseline characteristics between the two groups except that the splenic volumes were larger in Group 1 than 2. B-RTO was technically successful in 21 of 23 patients (91.3%) in Group 1 and in 12 of 13 patients (92.3%) in Group 2. In all patients with ruptured GVs (six in Group 1 and five in Group 2), complete hemostasis was obtained by B-RTO. Exacerbation of esophageal varices was significantly less frequent in Group 1 than 2 (p = 0.0017).
  
  
  CONCLUSIONS
  Concomitant PSE with B-RTO may contribute to prevention of the exacerbation of esophageal varices after B-RTO.
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Waguri
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Osaki
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Shunzo
authors.initials: S
authors.lastname: Ikarashi
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Naosuke
authors.initials: N
authors.lastname: Kuraoka
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Munehiro
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Aiba
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yoneyama
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Sugimura
authors.affiliation: Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan.
authors.forename: Kentarou
authors.initials: K
authors.lastname: Igarashi
keywords: Gastric varices; balloon-occluded retrograde transvenous obliteration; esophageal varices; partial splenic embolization; portal hypertension