Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study

• Main Authors: Se Young Jang, Go Heun Kim, Soo Young Park, Chang Min Cho, Won Young Tak, Jeong Han Kim, Won Hyeok Choe, So Young Kwon, Jae Myeong Lee, Sang Gyune Kim, Dae Yong Kim, Young Seok Kim, Se-Ok Lee, Yang Won Min, Joon Hyeok Lee, Seung Woon Paik, Byung Chul Yoo, Jae Wan Lim, Hong Joo Kim, Yong Kyun Cho, Joo Hyun Sohn, Jae Yoon Jeong, Yu Hwa Lee, Tae Yeob Kim, Young Oh Kweon
• Format: Article
• Language: English
• Published: Korean Association for the Study of the Liver 2012-12-01
• Series: Clinical and Molecular Hepatology
• Subjects: Balloon-occluded retrograde transvenous obliteration; Esophageal varices; Gastric varices; Liver cirrhosis; Variceal hemorrhage
• Online Access: http://e-cmh.org/upload/pdf/cmh-18-368.pdf
• ISSN: 2287-2728; 2287-285X

Background/AimsThis study evaluated the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC).MethodsWe retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010.ResultsOf the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0±29.2 months (mean±SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047).ConclusionsBRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.