Short-Term Rebleeding Rates for Isolated Gastric Varices Managed by Transjugular Intrahepatic Portosystemic Shunt versus Balloon-Occluded Retrograde Transvenous Obliteration |
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| Affiliation: | 1. Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908;2. Department of Radiology and Medical Imaging, and Division of Gastroenterology, Department of Medicine, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908;3. Department of Diagnostic Radiology, National Institutes of Health, Bethesda, Maryland;4. South Florida Vascular Associates, Coconut Creek, Florida;1. Department of Radiology, Kenyatta National Hospital, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya;2. Department of Vascular and Interventional Radiology, Hadassah University Hospital, Jerusalem, Israel;1. Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan;2. Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan;3. Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan;4. NeoChemir, Kobe, Japan;5. Miwa Orthopaedic Clinic, Himeji, Japan;1. Department of Radiology, Washington Hospital Center, Washington, DC;2. MedStar Washington Hospital Center Credentials and Peer Review Committee, Washington Hospital Center, Washington, DC;3. Section of Peripheral Interventional Radiology, Washington Hospital Center, Washington, DC;1. University of Texas Medical School at Houston, 1515 Holcombe Blvd., Unit 1471 Houston, TX 77030-4009;2. Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471 Houston, TX 77030-4009 |
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| Abstract: | PurposeTo assess the short-term rebleeding rate associated with the use of a transjugular intrahepatic portosystemic shunt (TIPS) compared with balloon-occluded retrograde transvenous obliteration (BRTO) for management of gastric varices (GV).Materials and MethodsA single-center retrospective comparison of 50 patients with bleeding from GV treated with a TIPS or BRTO was performed. Of 50 patients, 27 (17 men and 10 women; median age, 55 y; range, 31–79 y) received a TIPS with covered stents, and 23 (12 men and 11 women; median age, 52 y; range, 23–83 y) underwent a BRTO procedure with a foam sclerosant. All study subjects had clinical and endoscopic evidence of isolated bleeding GV and were hemodynamically stable at the time of the procedure. Clinical and endoscopic follow-up was performed. Kaplan-Meier analysis was used to evaluate rebleeding rates from the GV.ResultsThe technical success rate was 100% in the TIPS group and 91% in the BRTO group (P = .21). Major complications occurred in 4% of the patients receiving TIPS and 9% of patients the undergoing BRTO (P = .344). Encephalopathy was reported in 4 of 27 (15%) patients in the TIPS group and in none of the patients in the BRTO group (0%; P = .12). At 12 months, the incidence of rebleeding from a GV source was 11% in the TIPS group and 0% in the BRTO group (P = .25).ConclusionsBRTO appears to be equivalent to TIPS in the short-term for management of bleeding GV. Further comparative studies are warranted to determine optimal management strategies in individual patients. |
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| Keywords: | BRTO" },{" #name" :" keyword" ," $" :{" id" :" key0010" }," $$" :[{" #name" :" text" ," _" :" balloon-occluded retrograde transvenous obliteration EV" },{" #name" :" keyword" ," $" :{" id" :" key0020" }," $$" :[{" #name" :" text" ," _" :" esophageal varices GV" },{" #name" :" keyword" ," $" :{" id" :" key0030" }," $$" :[{" #name" :" text" ," _" :" gastric varices PSG" },{" #name" :" keyword" ," $" :{" id" :" key0040" }," $$" :[{" #name" :" text" ," _" :" portosystemic gradient TIPS" },{" #name" :" keyword" ," $" :{" id" :" key0050" }," $$" :[{" #name" :" text" ," _" :" transjugular intrahepatic portosystemic shunt |
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