Long‐term results of balloon‐occluded retrograde transvenous obliteration for gastric fundal varices: Hepatic deterioration links to portosystemic shunt syndrome

Abstract

Background and Aims: It is well known that a large portosystemic shunt develops during portal hypertension. In this study, we studied the long-term effects of a large splenorenal shunt (SRS) on liver function and survival. Methods: The subjects were divided into three groups: an SRS (-) group consisting of cirrhotic patients without SRS; an SRS (+) group consisting of patients with gastric fundal varices and SRS; and a balloon-occluded retrograde transvenous obliteration (B-RTO) group with a completely obliterated SRS by B-RTO. We compared the following among these groups: the total bilirubin levels, serum albumin levels, prothrombin times, changes in Child-Pugh scores, and survival rates. Results: After a 3-year follow-up period the Child-Pugh scores showed significant differences among the SRS (+), SRS (-), and B-RTO groups. The score worsened for the SRS (+) group. The cumulative survival rates were significantly different between the SRS (+) and SRS (-) groups and between the SRS (+) and B-RTO groups. The vital prognosis worsened for the SRS (+) group. Conclusions: The presence of a large splenorenal shunt (portosystemic shunt) was indicated to lower liver function and vital prognosis. B-RTO, which completely obliterates large splenorenal shunts, inhibited the lowering of hepatic functional reserve and the worsening of vital prognosis, indicating a protective role. Liver pathology and the presence of a large portosystemic shunt each separately result in progressive liver dysfunction and worsen the survival rate. We found that such a pathological condition had occurred due to a large portosystemic shunt, and it should be called 'portosystemic shunt syndrome.'

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis

“…Only human studies were included. We included studies reporting results of BRTO for management of acute bleeding or at-risk gastric varices in 10 or more patients (at-risk gastric varices were defined as those demonstrating findings of erythema or enlargement [18]). Duration of follow-up was not a specific exclusion criterion, as both short-term and long-term criteria were being evaluated for the purpose of this study.…”

Improvement in survival associated with embolisation of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy

“…15 Therefore, embolisation of SPSS could restore hepatic blood flow and possibly improve liver function and survival of patients.…”

Imaging and radiological interventions in extra-hepatic portal vein obstruction

“…Portal vein thrombosis (PVT) in EHPVO leads to PHT which acts as a stimulus for spontaneous PSS which is predictor of poor prognosis and a cause of HE [68] .…”