The Clinical Results of Balloon-Occluded Retrograde Transvenous Obliteration in Treatment of Gastric Varices Compared with Transjugular Intrahepatic Portosystemic Shunt

ABSTRACT

PURPOSE: To compare the clinical results of BRTO in the gastric varices with those of TIPS. MATERIALS AND METHODS: From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with that of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. Results:In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n=4), encephalopathy (n=7) and a worsening of the gastric (n=5) or esophageal varices (n=2) occurred. CONCLUSION: BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO.