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DOI:10.2214/AJR.07.2266
AJR 2007; 189:W365-W372
© American Roentgen Ray Society

Original Research

Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: Outcomes and Complications in 49 Patients

Sung Ki Cho1, Sung Wook Shin1, In Ho Lee1, Young Soo Do1, Sung Wook Choo1, Kwang Bo Park1 and Byung Chul Yoo2

1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Kangnam-ku, Seoul 135-710, Korea.
2 Department of Medicine, Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

OBJECTIVE. Our aim was to evaluate the clinical outcomes, techniques, and complications of balloon-occluded retrograde transvenous obliteration for treating gastric varices with spontaneous gastrosystemic shunts.

MATERIALS AND METHODS. From November 2002 through October 2005, 49 consecutive patients with gastric varices were treated by balloon-occluded retrograde transvenous obliteration. The sclerosant was injected through the outflow veins during balloon occlusion. Immediate postprocedural CT scans were obtained to evaluate the procedural details. Recurrence and rebleeding of gastric varices and worsening of esophageal varices were evaluated by endoscopic examination and CT. The survival rates and prognostic factors after the procedure were also assessed.

RESULTS. There were six procedural failures and two procedure-related deaths. Disappearance or marked shrinkage of the treated gastric varices with no recurrent gastric variceal bleeding was noted in 39 patients (79.6% clinical success rate). Approximately two thirds of our patients experienced worsening of esophageal varices during the median follow-up period of 457 days. The cumulative survival rates at 1 year and 3 years after balloon-occluded retrograde transvenous obliteration were 83.1% and 65.7%, respectively. The prognostic factors associated with survival were the preprocedural Child-Pugh classification and the total bilirubin level. The survival rates and procedural outcomes for the patients with severely compromised liver function were poor.

CONCLUSION. Balloon-occluded retrograde transvenous obliteration is an effective treatment for the obliteration of gastric varices. However, application of this procedure to severely compromised patients should be considered carefully.

Keywords: balloon-occluded retrograde transvenous obliteration • embolization • gastric varices • interventional radiology


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