Long-term Results of Balloon-Occluded Retrograde Transvenous Obliteration for the Treatment of Gastric Varices and Hepatic Encephalopathy

Fukuda, Tsuyoshi; Hirota, Shun; Sugimura, Kazuro

doi:10.1016/s1051-0443(07)61912-5

Cited by 271 publications

(369 citation statements)

References 19 publications

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“…In addition, hepatic portal blood flow and portal pressures have been shown to increase after BRTO. This may improve liver function (50% of patients had an improvement in Child-Pugh score in one study), but can worsen the size of varices at other sites (potentially increasing the risk of bleeding) and may exacerbate ascites [81][82][83][84]. Hepatic encephalopathy may also improve following BRTO, but whether this beneficial effect is sustained long-term remains unknown [83].…”

Section: Brtomentioning

confidence: 99%

The Management of Bleeding from Anorectal Varices

Robertson

Thompson

Hayes

2017

Curr Hepatology Rep

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Purpose of Review The purpose of this review is to summarize available strategies for the diagnosis and management of bleeding anorectal varices. Recent Findings Interventional radiological procedures, including TIPS, BRTO and/or embolization, have been established as efficacious treatments, particularly in the setting of treatment failure. Summary Anorectal varices are prevalent in patients with portal hypertension. Acute bleeding is uncommon, but can be massive and life-threatening. Anorectal varices should be considered as a differential diagnosis in any patient with cirrhosis or portal hypertension who presents with lower gastrointestinal bleeding. No evidence-based guidelines exist to guide the management of bleeding anorectal varices, which typically requires a multidisciplinary team of endoscopists, hepatologists, surgeons and interventional radiologists. Administration of prophylactic antibiotics and vasoactive therapy is recommended based on efficacy in bleeding oesophageal varices. Urgent endoscopy should be performed in all patients. Endoscopic sclerotherapy has the greatest body of evidence and should be considered the first-line therapy; efficacy and safety may be increased if this is performed with endoscopic ultrasound. Endoscopic banding or obturation are alternative first-line treatments; all methods offer a technically simple and efficacious method of achieving haemostasis, and local expertise will determine which procedure is employed.

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Section: Brtomentioning

confidence: 99%

The Management of Bleeding from Anorectal Varices

Robertson

Thompson

Hayes

2017

Curr Hepatology Rep

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“…The BRTO technique has been described in many reports (4)(5)(6)(7) and has shown considerable effectiveness with low rebleeding rates (4)(5)(6)(7)(8)(9)(10). Its advantages over TIPS include less invasiveness and greater performance ease in patients with poor hepatic reserve, encephalopathy, or refractory ascites (2,7,8).…”

Section: Balloon-occluded Retrograde Transvenous Obliteration (Brto)mentioning

confidence: 99%

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Lee

Park

et al. 2016

J Korean Soc Radiol

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Purpose:To evaluate the short-term outcome of plug-assisted retrograde transvenous obliteration (PARTO) using vascular plugs and gelatin sponges in comparison with balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Materials and Methods: From January 2005 to October 2014, 171 patients were referred for management of gastric varices, of which, 52 patients with hemodynamically stable gastric varices (48 recent bleeding; 4 primary prophylaxes) were evaluated. Of these, 38 received BRTO (men/women 23/15; mean age 61.3; Child-Pugh classes A/B/C = 11/25/2) and 14 underwent PARTO (men/women 11/3; mean age 63.4; ChildPugh classes A/B/C = 9/4/1). The technical success rate, complications, variceal changes, liver function, and exacerbation of ascites/pleural effusion were compared between the 2 groups within 3 months after the procedure. Results: The technical success rates were 92.1% in the BRTO and 100% in the PARTO group. Procedure-related early complications occurred in the BRTO group alone (8%, n = 3). Among patients with technical success, follow-up CT at 1 month was available for 98% (n = 48/49). Complete thrombosis of gastric varices was achieved in 97.1% in the BRTO and 100% in the PARTO group. Worsening of esophageal varices was observed in 24% of the BRTO group alone (n = 8). The albumin level increased significantly in both groups and aspartate aminotransferase/alanine aminotransferase level improved significantly in the PARTO group (p < 0.05). Exacerbation of ascites/pleural effusion was observed in both groups (35.2% vs. 21.4%, both p > 0.05). Conclusion: PARTO appears to be equivalent to BRTO for short-term management of gastric varices.

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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%

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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Long-term Results of Balloon-Occluded Retrograde Transvenous Obliteration for the Treatment of Gastric Varices and Hepatic Encephalopathy

Cited by 271 publications

References 19 publications

The Management of Bleeding from Anorectal Varices

The Management of Bleeding from Anorectal Varices

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

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

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