Balloon-Occluded Retrograde Transvenous Obliteration versus Endoscopic Injection Sclerotherapy for Isolated Gastric Varices : A Comparative Study

Abstract

Isolated gastric varices (IGV) have a lower risk of bleeding than esophageal varices, however IGV bleeding is associated with a higher mortality than bleeding of esophageal varices. In recent years, two widely used treatments for IGV have been balloon-occluded retrograde transvenous obliteration (B-RTO) and endoscopic injection sclerotherapy (EIS) using cyanoacrylate or ethanolamine oleate (EO). This study compared these two treatment methods for IGV. The subjects were 112 patients who were treated at our hospital for IGV bleeding between October 1990 and December 2003. Forty-nine (49) patients were treated with B-RTO and 63 patients with EIS. These two patient groups were compared as regards content of treatment, post-treatment incidence of variceal bleeding, incidence of IGV rebleeding, survival rate, cause of death, and complications. Multivariate analysis was performed on post-treatment variceal bleeding and survival. Although EO was used in higher amounts in the B-RTO group than in the EIS group, the B-RTO group had a significantly lower number of treatment sessions and a significantly shorter treatment period (p<0.05). The EIS group had significantly more patients with IGV rebleeding after treatment than the B-RTO group. Treatment method was the only independent prognostic factor of IGV bleeding after treatment (p=0.024). The two groups did not differ significantly in the percentage of patients with aggravated esophageal varices after treatment. Bleeding from ectopic varices was not observed in any patient. There was no significant difference in survival by treatment method. The presence of hepatocellular carcinoma was the only independent prognostic factor for survival (p=0.003). It is concluded that B-RTO was more effective than EIS in the eradication of IGV and prevention of IGV recurrence and rebleeding.

Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

“…In several studies, B-RTO was superior to TIPS placement and endoscopic interventions for GVs. 16,17,[27][28][29][30][31] However, B-RTO blocks the GRS, which is a high-flow portosystemic shunt, resulting in increased PVP. Deterioration of EV due to increased PVP after B-RTO is a major issue in the long-term management of these patients.…”

Balloon‐occluded retrograde transvenous obliteration versus endoscopic injection for gastric variceal bleeding: a systematic review and meta‐analysis

“…Of the 48 articles selected for full review, 43 were excluded for not meeting the inclusion criteria or repeated data from the same study centre . Five studies (n = 453) ultimately met the inclusion criteria and were included in meta‐analysis . (Figure ) summarises the selection process.…”

“…All of studies compared the therapeutic results of endoscopic injection therapy and BRTO in patients with gastric variceal haemorrhage. Two of the studies were prospective cohorts and three were retrospective cohorts . All studies used cyanoacrylate injection therapy as the primary and first modality to control active variceal bleeding and achieve hemostasis.…”

“…All studies used cyanoacrylate injection therapy as the primary and first modality to control active variceal bleeding and achieve hemostasis. In Emori and Akahoshi studies, ethanolamine oleate was used after hemostasis was achieved for prevention of rebleeding from GV . After the patients’ general condition stabilised, elective endoscopic injection therapy with CA and EO was usually performed within 24 hours in Emori study and within 3 days in Akahoshi study and repeated weekly until the residual GVs were obstructed.…”

“…In the BRTO groups CT abdomen was performed after treatment to confirm thrombosis of varices and upper gastrointestinal endoscopy was then performed for follow‐up in different time intervals. The overall follow‐up period averaged 76 months in Min study, 13 months in Hong study, 78 months in Akahoshi study, 42 months in Emori study, and 16 months in the study conducted by Stein . Basic characteristics of the included studies are shown in (Table ).…”