Prophylactic transileocolic obliteration of esophageal varices after balloon-occluded retrograde transvenous obliteration of gastric varices with a gastrorenal shunt

Several non-surgical techniques have been developed to treat esophagogastric varices that occur secondary to portal hypertension, including those performed endoscopically or with interventional radiologic therapies. In patients with large gastric fundal varices and associated gastrorenal shunting, controversy still remains in defining the most appropriate non-surgical intervention. Balloon-occluded retrograde transvenous obliteration has been shown to be one effective treatment for gastric varices in these instances. However, in the population treated in this manner, the inhibition of subsequent esophageal varices is essential. We report a patient with gastric fundal varices that were successfully treated using balloon-occluded retrograde transvenous obliteration and in whom prophylactic transileocolic obliteration of esophageal varices was additionally performed. This 46-year-old man was diagnosed with severe gastric varices and gastrorenal shunting with only mild esophageal varices. Five years after therapy, the patient demonstrates no evidence of recurrence of either gastric or esophageal varices and has remained otherwise healthy.