Korean J Radiol.  2017 Apr;18(2):345-354. 10.3348/kjr.2017.18.2.345.

Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices

Affiliations
  • 1Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO 63110, USA. skim35@wustl.edu
  • 2Division of Gastroenterology, Department of Internal Medicine, Washington University St. Louis School of Medicine, St. Louis, MO 63110, USA.
  • 3Department of Radiology, Kyung Hee University College of Medicine, Seoul 02447, Korea.

Abstract


OBJECTIVE
Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience.
MATERIALS AND METHODS
We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRTO. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups.
RESULTS
There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months.
CONCLUSION
BRTO is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy.

Keyword

Gastric varices; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Balloon-occluded retrograde transvenous obliteration

MeSH Terms

Adult
Aged
Aged, 80 and over
Ascites/etiology
*Balloon Occlusion/adverse effects
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/mortality/*therapy
Female
Gastrointestinal Hemorrhage/etiology
Hepatic Encephalopathy/etiology
Humans
Male
Middle Aged
*Portasystemic Shunt, Transjugular Intrahepatic/adverse effects
Retrospective Studies
Stents
Survival Rate
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