Gut Liver.  2018 Nov;12(6):704-713. 10.5009/gnl17515.

Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding

Affiliations
  • 1Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. yoonjun@snu.ac.kr
  • 3Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Gastric varices (GVs) are a major cause of upper gastrointestinal bleeding in patients with liver cirrhosis. The current treatments of choice are balloon-occluded retrograde transvenous obliteration (BRTO) and the placement of a transjugular intrahepatic portosystemic shunt (TIPS). We aimed to compare the efficacy and outcomes of these two methods for the management of GV bleeding.
METHODS
This retrospective study included consecutive patients who received BRTO (n=157) or TIPS (n=19) to control GV bleeding from January 2005 to December 2014 at a single tertiary hospital in Korea. The overall survival (OS), immediate bleeding control rate, rebleeding rate and complication rate were compared between patients in the BRTO and TIPS groups.
RESULTS
Patients in the BRTO group showed higher immediate bleeding control rates (p=0.059, odds ratio [OR]=4.72) and lower cumulative rebleeding rates (log-rank p=0.060) than those in the TIPS group, although the difference failed to reach statistical significance. There were no significant differences in the rates of complications, including pleural effusion, aggravation of esophageal varices, portal hypertensive gastropathy, and portosystemic encephalopathy, although the rate of the progression of ascites was significantly higher in the BRTO group (p=0.02, OR=7.93). After adjusting for several confounding factors using a multivariate Cox analysis, the BRTO group had a significantly longer OS (adjusted hazard ratio [aHR]=0.44, p=0.01) and a longer rebleeding-free survival (aHR=0.34, p=0.001) than the TIPS group.
CONCLUSIONS
BRTO provides better bleeding control, rebleeding-free survival, and OS than TIPS for patients with GV bleeding.

Keyword

Balloon-occluded retrograde transvenous obliteration; Portasystemic shunt, transjugular intrahepatic; Variceal bleeding

MeSH Terms

Ascites
Esophageal and Gastric Varices*
Hemorrhage
Hepatic Encephalopathy
Humans
Korea
Liver Cirrhosis
Odds Ratio
Pleural Effusion
Portasystemic Shunt, Surgical*
Portasystemic Shunt, Transjugular Intrahepatic
Retrospective Studies
Tertiary Care Centers
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