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Procedure for Gastric Variceal Bleeding: From BRTO to PARTO to CARTO, Three Decades of Progress

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Liver Diseases

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Abstract

Gastric varices are less common than esophageal varices. However, it is known to be associated with a poor prognosis and mortality due to its high propensity to bleed massively. There are several management options for gastric variceal bleeding including medical management, endoscopic treatment, transjugular intrahepatic portosystemic shunt, shunt surgery, and liver transplantation. However, clinical outcomes and recurrent bleeding rate of these current treatments are widely varying, and an alternative treatment method for gastric variceal bleeding is needed. In this chapter, we present a relatively novel treatment option for gastric varices called BRTO (Balloon-occluded retrograde transvenous obliteration) and its modified methods. In brief, BRTO and modified BRTO (PARTO = plug-assisted or CARTO = coil-assisted retrograde transvenous obliteration) appear safe and effective treatment options for gastric variceal bleeding.

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Author information

Authors and Affiliations

  1. Interventional Radiology and Liver/Pancreas Transplant Surgery, UCLA Medical Center, Los Angeles, CA, USA

    Edward Wolfgang Lee

  2. Interventional Radiology, UCLA Medical Center, Los Angeles, CA, USA

    Damian Hall

Authors
  1. Edward Wolfgang Lee
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  2. Damian Hall
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Corresponding author

Correspondence to Edward Wolfgang Lee .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    Which statement is true?

    1. (a)

      BRTO and modified BRTO is to treat esophageal varices.

    2. (b)

      Gastric variceal bleeding always occurs at the highest portosystemic gradient.

    3. (c)

      CARTO requires sclerosing agent such as EO.

    4. (d)

      TIPS should not be performed in patients with severe hepatic encephalopathy.

  2. 2.

    Which statement is true?

    1. (a)

      BRTO should not be performed in patients with HE as BRTO may worsen HE.

    2. (b)

      BRTO creates a shunt between a portal vein and a hepatic vein.

    3. (c)

      SPSSs can be often seen in patients with cirrhosis and portal hypertension

    4. (d)

      PARTO requires sclerosing agent such as EO

1.2 Answers

  1. 1.

    Which statement is true?

    • (d) TIPS should not be performed in patients with severe hepatic encephalopathy.

  2. 2.

    Which statement is true?

    • (c) SPSSs can be often seen in patients with cirrhosis and portal hypertension

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Lee, E.W., Hall, D. (2020). Procedure for Gastric Variceal Bleeding: From BRTO to PARTO to CARTO, Three Decades of Progress. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_56

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