Balloon‐occluded retrograde transvenous obliteration for gastric varices improves hepatic functional reserve in long‐term follow‐up

Abstract

Background and Aim: Balloon-occluded retrograde transvenous obliteration (BRTO) has been widely adopted for the management of gastric fundal varices (GVs). There are a few reports that BRTO leads to the improvement of mid-term and long-term hepatic functional reserve (HFR). We retrospectively investigated the longterm effect on HFR and prognosis among patients who had undergone BRTO for GVs. Methods: This single-center, retrospective study included 57successful patients out of 60 patients who underwent BRTO for GVs from December 2005 to September 2018. We examined the indicators of HFR (e.g., encephalopathy and ascites statuses, serum total bilirubin and albumin levels, % prothrombin time, and Child-Pugh and albumin-bilirubin [ALBI] scores) during 3 years of follow-up after BRTO. We analyzed survival using the Kaplan-Meier method and identified the independent prognostic factors via multivariate analyses. Results: GVs disappeared in all patients who were successfully treated by BRTO. At 3 years after BRTO, serum albumin levels were significantly elevated (from 3.3 to 4.0 g/dL, P = 0.008), while Child-Pugh and ALBI scores were significantly decreased (from 7.0 to 5.7, P = 0.043, and from À1.94 to À2.60, P = 0.006, respectively). The median survival time among all patients was 2207 days; the survival rates after BRTO were 87.0% at 1 year, 81.8% at 3 years, 67.3% at 5 years, and 44.1% at 10 years. Multivariate analyses revealed that ascites, hepatic encephalopathy, and malignant neoplasms were independently associated with poor prognosis. Conclusion: BRTO for GVs has a favorable effect on long-term HFR.

Short and long term outcomes of Balloon-occluded Retrograde Transvenous Obliteration (BRTO) in gastric varices patients: A retrospective analysis

“…The encephalopathy was resolved or signi cantly reduced in all 35 patients evaluated in ve studies (3,8,9,21,22). Also, another study found that serum albumin levels in gastric varices patients improved considerably at three years following the BRTO procedure (23). In a study by Kumamoto et al analyzing the long-term effects of a large splenorenal shunt (SRS) on liver function and survival, patients have divided into three groups; patients with no gastrorenal shunt (the control group), patients with untreated gastrorenal shunt and patients with gastrorenal shunts treated with BRTO.…”

Balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

“… 19 BRTO has a favorable effect on long-term hepatic functional reserve. 20 Comparisons between BRTO and TIPS have always been controversial. A retrospective study by Lee et al.…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“… Waguri et al. 112 Retrospective 57 Liver function after B-RTO ALBI scores and Child-Pugh class significantly decreased 3 years after B-RTO. Ishikawa et al.…”

“… [108] , [109] , [110] , [111] Further, the improvement of liver function associated with balloon-occluded retrograde transvenous obliteration for gastric varices or administration of rifaximin to control hyperammonaemia have been analysed with the ALBI score. 112 , 113 …”

“…Conversely, the restoration of liver function in association with viral eradication or suppression by nucleot(s)ide analogues for HBV or IFN-based or DAA-based therapy for HCV have been characterized by the decrease in ALBI score [108][109][110][111]. Further, the improvement of liver function associated with balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices or administration of rifaximin to control hyperammonemia have been analyzed with the ALBI score [112,113].…”