Clin Mol Hepatol.  2012 Dec;18(4):368-374. 10.3350/cmh.2012.18.4.368.

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

Affiliations
  • 1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. yokweon@mail.knu.ac.kr
  • 2Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul & Choongju, Korea.
  • 3Department of Internal Medicine & Radiology, Soonchunhyang University College of Medicine, Bucheon, Korea.
  • 4Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Kangbook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea.

Abstract

BACKGROUND/AIMS
This 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).
METHODS
We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010.
RESULTS
Of 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).
CONCLUSIONS
BRTO 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.

Keyword

Balloon-occluded retrograde transvenous obliteration; Esophageal varices; Gastric varices; Liver cirrhosis; Variceal hemorrhage

MeSH Terms

Adult
Aged
Asian Continental Ancestry Group
*Balloon Occlusion/adverse effects
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/*complications
Female
Follow-Up Studies
Gastrointestinal Hemorrhage/etiology/prevention & control/*therapy
Humans
Liver Cirrhosis/*complications
Male
Middle Aged
Odds Ratio
Pulmonary Embolism/etiology
Recurrence
Republic of Korea
Retrospective Studies
Severity of Illness Index
Treatment Outcome
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