Balloon‐occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension

Miyamoto, Yoshinori; Oho, Kazuhiko; Kumamoto, Masafumi; Toyonaga, Atsushi; Sata, Michio

doi:10.1046/j.1440-1746.2003.03087.x

Cited by 109 publications

(111 citation statements)

References 32 publications

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“…Nutritional factors such as insulin and glucagons are favorable for maintaining normal liver function [1,2] . Portal hypertension is important in maintaining hepatopetal blood flow during liver cirrhosis [3][4][5][6] . The present study showed that FPP of the pre-PAD-operation decreased by 0.59 kPa averagely compared to that of post-PAD-operation (P<0.01).…”

Section: Portacaval Shunt For Patients With Portal Hypertension Combimentioning

confidence: 99%

Clinical analysis of surgical treatment of portal hypertension

Cai²,

Leng³

et al. 2005

WJG

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AIM:To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions. METHODS:The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization (PAD), 167 with portasystemic shunt (PSS), 62 with selective shunt (SS), 11 with combined portasystemic shunt and portaazygous devascularization (PSS+PAD), 9 with liver transplantation (LT), 3 with union operation for hepatic carcinoma and portal hypertension (HCC+PH). RESULTS:In the 167 patients treated with PSS, free portal pressure (FPP) was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation (P<0.01). After the operation, FPP in the former patients markedly decreased compared to the latter ones (P<0.01). The incidence rate of hemorrhage in patients treated with PAD, PSS, SS, PSS+PAD, and HCC+PH was 21.09% (54/256), 13.77 (23/167), 11.29 (7/62), 36.36% (4/11), and 100% (3/3), respectively. The incidence rate of hepatic encephalopathy was 3.91% (10/256), 9.58% (16/167), 4.84% (3/62), 9.09% (1/11), and 100% (3/3), respectively while the operative mortality was 5.49% (15/256), 4.22% (7/167), 4.84% (3/62), 9.09% (1/11), and 66.67% (2/3) respectively. The operative mortality of liver transplantation was 22.22% (2/9). CONCLUSION:Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.

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Section: Portacaval Shunt For Patients With Portal Hypertension Combimentioning

confidence: 99%

Clinical analysis of surgical treatment of portal hypertension

Cai²,

Leng³

et al. 2005

WJG

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“…B-RTO is also reported to augment portal venous blood flow and improve liver function test findings [214,215]. An elevated hepatic venous pressure gradient after B-RTO is one aspect of the effect of liver function [215].…”

Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 98%

“…Comment: Several noncontrolled case series reported that the occlusion of the large portosystemic shunt by B-RTO relieves hepatic encephalopathy [212][213][214][215]. B-RTO is also reported to augment portal venous blood flow and improve liver function test findings [214,215].…”

Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…The patient would then return for a second and possibly a third session if the gastric varices were not completely obliterated. 9,10,19,22,24 The second strategy was to use an adjunct sclerosant such as 50% glucose solution or absolute alcohol to keep the 5% ethanolamine oleate dose/volume to less than 40 mL. 4,8,17,19 Subsequently, American interventionalists introduced a new sclerosant: 3% Sotradecol, to perform the .…”

Section: Conception and Evolution Of The Brto Proceduresmentioning

confidence: 99%

“…9,10,19,22,24 The second strategy was to use an adjunct sclerosant such as 50% glucose solution or absolute alcohol to keep the 5% ethanolamine oleate dose/volume to less than 40 mL. 4,8,17,19 Subsequently, American interventionalists introduced a new sclerosant: 3% Sotradecol, to perform the . This has caused some Japanese institutions to reconsider use of their ethanolamine oleate concoctions by mixing them with air to create a frothy consistency to the sclerosant with its desired sclerosant dose reduction (relative to volume) and the frothy percolative effect of the sclerosant.…”

Section: Conception and Evolution Of The Brto Proceduresmentioning

confidence: 99%

The History and Evolution of Balloon-occluded Retrograde Transvenous Obliteration (BRTO): From the United States to Japan and Back

Saad

2011

Semin intervent Radiol

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The concept of obliterating varices that complicate portal hypertension dates back to the 1970s, but its minimally invasive clinical utilization was probably lost with the advent of the transjugular intrahepatic portosystemic shunt (TIPS). The conception of retrograde obliteration of a gastrorenal shunt via the left renal vein was reported by Olson et al from the University of Indiana. However, the definition, development, technical perfection, and clinical implementation of the balloon-occluded retrograde transvenous obliteration (BRTO) occurred in Japan (by Kanagawa et al and others). The BRTO-procedure is currently undergoing a renaissance in the United States particularly for patients who are not TIPS candidates.

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Balloon‐occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension

Abstract: From short-term assessment, B-RTO increases hepatic blood flow and improves the metabolic activity of the liver in patients with portal hypertension.

Cited by 109 publications

References 32 publications

Clinical analysis of surgical treatment of portal hypertension

Clinical analysis of surgical treatment of portal hypertension

Evidence-based clinical practice guidelines for liver cirrhosis 2015

The History and Evolution of Balloon-occluded Retrograde Transvenous Obliteration (BRTO): From the United States to Japan and Back

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