title: Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature.
abstract: Bleeding gastric varices (GV) are managed by cyanoacrylate glue injection with transjugular intrahepatic portosystemic shunt (TIPSS) as modality for treatment failure. Ulcer can form at the site of glue injection over GV and it can cause bleeding. Treatment approach for such bleed is not well described. Balloon-occluded retrograde transvenous obliteration (BRTO), TIPSS, and devascularization remain the treatment options in this scenario. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. BRTO has the benefit of increasing portal hepatic blood flow and can also be useful in patients who may not tolerate TIPSS. We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV.
authors.affiliation: Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Prajapati
authors.affiliation: Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Piyush
authors.initials: P
authors.lastname: Ranjan
authors.affiliation: Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Ajit K
authors.initials: AK
authors.lastname: Yadav
keywords: BRTO, balloon-occluded retrograde transvenous obliteration; EVL, endoscopic variceal ligation; GV, gastric varices; TIPSS, transjugular intrahepatic portosystemic shunt; UGI, upper gastrointestinal; balloon-occluded retrograde transvenous obliteration; gastric varices; glue ulcer