Gastric Varices occur as a result of portal hypertension. Balloon Retrograde Transvenous Obliteration (BRTO) is a modality for managing gastric varices. The ultimate goal of this review is to promote the broader adoption of BRTO in managing gastric varices and to promote further research to improve patient outcomes. Before this study, an electronic literature search was undertaken based on identified concepts, keywords, and other pertinent descriptions. Search databases were developed and included “Gastric varices” AND “BRTO” OR “intervention” OR “treatment” OR “procedure” OR “glue” OR “adhesive”. The databases selected and thoroughly searched were PubMed, Cochrane Library and ScienceDirect. Following the first search, 274 articles were found in total. By applying inclusion criteria of full-text articles and a period of fewer than five years, the database was reduced to 37 articles, which was then further filtered to include only articles on adults over 19 years old, leaving a total count of 17 articles. BRTO is a relatively simple procedure to perform once the essential skill is attained and helpful in both emergency and elective management of gastric varices. Its use still needs to be improved by the unavailability and lack of skills. However, there are side effects associated with BRTO as it causes elevation of portal hypertension, recurrent bleeding, hemoglobinuria and pain post procedure. This review emphasizes the need for further research in this field, focusing on refining patient selection criteria, improving the technical aspect of the procedure and enhancing long-term outcomes.

Background: Pegylated interferon (PEG-IFN) plus ribavirin combination was themain treatment for chronic hepatitis C (CHC) patients in Pakistan till 2016. An important sideeffect of this combination was thyroid dysfunction (TD). Objectives: To evaluate thyroid functionabnormalities in Chronic Hepatitis C patients treated with PEG-IFN and ribavirin. Study Design:Descriptive study. Setting: Outpatient Department of Gastroenterology and Hepatology,Nishtar Hospital Multan. Period: January to September 2016. Methods: Using non-probabilityconsecutive sampling. There were 337 CHC patients enrolled in the study who fulfilled theinclusion criteria. Patients were given PEG-IFN plus ribavirin combination therapy and at 12weeks their serum Thyroid Stimulating Hormone (TSH) levels were measured to identify any TD.Data was entered and analyzed by computer program SPSS-17. Results: Of these 337 cases,211 (62.6%) were male patients while 126 (37.4%) were female patients. Mean age of our caseswas noted to be 30.92 ± 5.84 years. Mean disease duration was 16.19 ± 6.42 months. In ourstudy 98 patients (29.1%) had genotype 2 while 239 (70.9%) had genotype 3. TD was seenin 28 (8.3%) patients, 70% of whom were females. Equal number of cases of Hypothyroidismand hyperthyroidism were seen (14 each). Hypothyroidism was significantly associated withrelatively older age group patients and genotype 3 (p value <0.05). A statistically significantassociation (p<0.05) was found between hyperthyroidism and genotype 3, female gender andyounger patients. Conclusion: PEG-IFN plus ribavirin combination therapy induces TD amongpatients with CHC with equal incidence of hypothyroidism and hyperthyroidism.

Din 4 , Anum Khakwani 5 , Asim Tameez Ud Din 6 ABSTRACT… Background: Pegylated interferon (PEG-IFN) plus ribavirin combination was the main treatment for chronic hepatitis C (CHC) patients in Pakistan till 2016. An important side effect of this combination was thyroid dysfunction (TD). Objectives: To evaluate thyroid function abnormalities in Chronic Hepatitis C patients treated with PEG-IFN and ribavirin. Study Design: Descriptive study.