Abstract
Purpose
To determine whether pretreatment portal flow direction can predict different clinical manifestations or prognosis after balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices.
Methods
The subjects were 103 cirrhotic patients with medium- or large-grade gastric varices treated by B-RTO. Short- and long-term clinical outcomes were compared among patients with forward portal flow (F group) and those with reversed or to-and-fro portal flow (R group) on color Doppler sonography before B-RTO.
Results
Deterioration of liver function reserve 1 year after B-RTO was more frequent in the R group (34.7 %) than in the F group (11.1 %, p = 0.0251). Thrombotic disorders within 1 year after B-RTO were also more frequent in the R group (20.7 %) than in the F group (2.7 %, p = 0.0079). There was no significant difference in cumulative survival rate of Child class A patients between the two groups. In Child class B or class C patients, however, the cumulative survival rate was poorer in the R group (68.7, 30.5, and 30.5 % at 1, 5, and 9 years, respectively) than in the F group (94.9, 58.8, and 37.8 % and 1, 5, and 9 years, respectively; p = 0.0097).
Conclusions
Hemodynamic assessment of portal flow direction is important before B-RTO, and care should be taken to manage thrombotic disorders in the perioperative period in patients with reversed portal flow after B-RTO. Another treatment option might be preferred for gastric varices in Child classes B and C patients with reversed portal flow instead of B-RTO, which may have a poor prognosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kim T, Shijo H, Kokawa H, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology 1997;25:307–312
Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 1986;32:264–268
Sarin SK, Sachdev G, Nanda R, et al. Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg 1988;75:747–750
Sarin SK, Lahoti D, Saxena SP, et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16:1343–1349
Akiyoshi N, Shijo H, Iida T, et al. The natural history and prognostic factors in patients with cirrhosis and gastric fundal varices without prior bleeding. Hepatol Res 2000;17:145–155
Kimura K, Ohto M, Matsutani S, et al. Relative frequencies of portosystemic pathways and renal shunt formation through the “posterior” gastric vein: portographic study in 460 patients. Hepatology 1990;12:725–728
Kanagawa H, Mima S, Kouyama H, et al. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 1996;11:51–58
Koito K, Namieno T, Nagakawa T, et al. Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. AJR Am J Roentgenol 1996;167:1317–1320
Hirota S, Matsumoto S, Tomita M, et al. Retrograde transvenous obliteration of gastric varices. Radiology 1999;211:349–356
Chikamori F, Kuniyoshi N, Shibuya S, et al. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery 2001;129:414–420
Ninoi T, Nishida N, Kaminou T, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR Am J Roentgenol 2005;184:1340–1346
Hiraga N, Aikata H, Takaki S, et al. The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol 2007;42:663–672
Maruyama H, Okugawa H, Kobayashi S, et al. Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices. Eur J Radiol 2010;75:e32–e37
Maruyama H, Ishihara T, Ishii H, et al. Blood flow parameters in the short gastric vein and splenic vein on Doppler ultrasound reflect gastric variceal bleeding. Eur J Radiol 2010;75:e41–e45
Okugawa H, Maruyama H, Kobayashi S, et al. Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein. Br J Radiol 2009;82:930–935
Tajiri T, Yoshida H, Obara K, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc 2010;22:1–9
Groszmann RJ, Glickman M, Blei AT, et al. Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology 1979;76:253–258
Barth KH, Udoff EJ. Transfemoral balloon catheterization for hepatic wedge pressure measurements. Radiology 1980;135:779–780
Shimoda R, Horiuchi K, Hagiwara S, et al. Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging 2005;30:306–313
Kumar DR, Hanlin E, Glurich I, et al. Virchow’s contribution to the understanding of thrombosis and cellular biology. Clin Med Res 2010;8:168–172
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kamezaki, H., Maruyama, H., Shimada, T. et al. Short- and long-term clinical outcome after balloon-occluded retrograde transvenous obliteration: is pretreatment portal flow direction a predictive factor?. Hepatol Int 7, 241–247 (2013). https://doi.org/10.1007/s12072-012-9376-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12072-012-9376-1