Journal of Gastroenterology

, Volume 42, Issue 8, pp 663–672

The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration

  • Nobuhiko Hiraga
  • Hiroshi Aikata
  • Shintaro Takaki
  • Hideaki Kodama
  • Hiroo Shirakawa
  • Michio Imamura
  • Yoshiiku Kawakami
  • Shoichi Takahashi
  • Naoyuki Toyota
  • Katsuhide Ito
  • Shinji Tanaka
  • Mikiya Kitamoto
  • Kazuaki Chayama
Liver, Pancreas, and Biliary Tract

DOI: 10.1007/s00535-007-2077-1

Cite this article as:
Hiraga, N., Aikata, H., Takaki, S. et al. J Gastroenterol (2007) 42: 663. doi:10.1007/s00535-007-2077-1

Abstract

Background

The purpose of our study was to evaluate the long-term outcome and complications of balloon-occluded retrograde transvenous obliteration (B-RTO) in patients with hemorrhage from gastric fundal varices.

Methods

Thirty-four consecutive patients with bleeding from gastric varices who were treated with B-RTO were enrolled in this study between December 1994 and September 2005 (urgent cases, n = 12; elective cases, n = 22). The long-term outcome, complications, and various liver functions were evaluated.

Results

Complete obliteration was achieved in 31 of 34 (91%) patients with an acute bleeding episode. In one of the remaining patients, there was a technical failure, and the other two had only partial obliteration. The two patients with partial obliteration did not obtain hemostasis. Thus, the rate of hemostasis was 94% (31/33). Gastric varices disappeared in all patients with complete obliteration during the treatment. The rate of gastric variceal eradication was 91%. Variceal rebleeding from esophageal varices occurred in three patients. The rate of rebleeding was 10% (3/31). Rebleeding from gastric varices was not observed after complete obliteration. None of the patients showed worsening of their Child-Pugh score. Although the 5-year cumulative worsening rate of esophageal varices was 52%, neither portal hypertensive gastropathy nor ectopic varices were observed. The patients with worsening esophageal varices were successfully treated with an endoscopic procedure. The 5-year survival rate was 68%.

Conclusions

B-RTO is useful for treatment of bleeding gastric varices, achieving high eradication of gastric varices, a low rebleeding rate, and a fairly good prognosis with improved hepatic function.

Key words

balloon-occluded retrograde transvenous obliteration (B-RTO) gastric fundal varices bleeding ethanolamine oleate 

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Nobuhiko Hiraga
    • 1
  • Hiroshi Aikata
    • 1
  • Shintaro Takaki
    • 1
  • Hideaki Kodama
    • 1
  • Hiroo Shirakawa
    • 1
  • Michio Imamura
    • 1
  • Yoshiiku Kawakami
    • 1
  • Shoichi Takahashi
    • 1
  • Naoyuki Toyota
    • 2
  • Katsuhide Ito
    • 2
  • Shinji Tanaka
    • 1
  • Mikiya Kitamoto
    • 1
    • 3
  • Kazuaki Chayama
    • 1
  1. 1.Department of Medicine and Molecular Science, Division of Frontier Medical SciencePrograms for Biomedical Research, Hiroshima UniversityHiroshimaJapan
  2. 2.Department of Clinical RadiologyGraduate School of Biomedical Sciences, Hiroshima UniversityHiroshimaJapan
  3. 3.Department of GastroenterologyHiroshima Prefectural HospitalHiroshimaJapan

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