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Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding
Gut and Liver ; : 704-713, 2018.
Article in English | WPRIM | ID: wpr-718116
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.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Pleural Effusion / Ascites / Portasystemic Shunt, Surgical / Esophageal and Gastric Varices / Odds Ratio / Hepatic Encephalopathy / Retrospective Studies / Portasystemic Shunt, Transjugular Intrahepatic / Tertiary Care Centers / Hemorrhage Type of study: Etiology study / Observational study Limits: Humans Country/Region as subject: Asia Language: English Journal: Gut and Liver Year: 2018 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Pleural Effusion / Ascites / Portasystemic Shunt, Surgical / Esophageal and Gastric Varices / Odds Ratio / Hepatic Encephalopathy / Retrospective Studies / Portasystemic Shunt, Transjugular Intrahepatic / Tertiary Care Centers / Hemorrhage Type of study: Etiology study / Observational study Limits: Humans Country/Region as subject: Asia Language: English Journal: Gut and Liver Year: 2018 Type: Article