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

  • Liver, Pancreas, and Biliary Tract
  • Published:
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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.

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Authors and Affiliations

  1. Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Nobuhiko Hiraga, Hiroshi Aikata, Shintaro Takaki, Hideaki Kodama, Hiroo Shirakawa, Michio Imamura, Yoshiiku Kawakami, Shoichi Takahashi, Shinji Tanaka, Mikiya Kitamoto & Kazuaki Chayama

  2. Department of Clinical Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Naoyuki Toyota & Katsuhide Ito

  3. Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Mikiya Kitamoto

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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 42, 663–672 (2007). https://doi.org/10.1007/s00535-007-2077-1

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