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Balloon-Occluded Transvenous Obliteration for Gastric Varices

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Abstract

Gastric varices (GVs) occur in the setting of liver cirrhosis and may result in life-threatening hemorrhage. Balloon-occluded retrograde transvenous obliteration (BRTO) is a minimally invasive image-guided intervention used to treat GVs that are actively, previously, or at high risk for bleeding. This chapter reviews GVs and BRTO in terms of epidemiology, anatomy, patient eligibility, procedure technique, and clinical outcomes.

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References

  1. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16:1343–9.

    Article  PubMed  CAS  Google Scholar 

  2. Butler JR, Eckert GJ, Zyromski NJ, Leonardi MJ, Lillemoe KD, Howard TJ. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford). 2011;13:839–45.

    Article  Google Scholar 

  3. Park JK, Saab S, Kee ST, et al. Balloon-occluded retrograde transvenous obliteration (BRTO) for treatment of gastric varices: review and meta-analysis. Dig Dis Sci. 2015;60:1543–53.

    Article  PubMed  Google Scholar 

  4. Ryan BM, Stockbrugger RW, Ryan JMA. Pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004;126:1175–89.

    Article  PubMed  Google Scholar 

  5. Kim T, Shijo H, Kokawa H, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25:307–12.

    Article  PubMed  CAS  Google Scholar 

  6. Sanyal AJ, Freedman AM, Luketic VA, et al. The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. Gastroenterology. 1997;112:889–98.

    Article  PubMed  CAS  Google Scholar 

  7. Saad WE, Darcy MD. Transjugular intrahepatic portosystemic shunt (TIPS) versus balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Semin Interv Radiol. 2011;28:339–49.

    Article  Google Scholar 

  8. Chao Y, Lin HC, Lee FY, et al. Hepatic hemodynamic features in patients with esophageal or gastric varices. J Hepatol. 1993;19:85–9.

    Article  PubMed  CAS  Google Scholar 

  9. Gaba RC, Couture PM, Lakhoo J. Gastroesophageal variceal filling and drainage pathways: an angiographic description of afferent and efferent venous anatomic patterns. J Clin Imaging Sci. 2015;5:61.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification. Radiographics. 2003;23:911–20.

    Article  PubMed  Google Scholar 

  11. Watanabe K, Kimura K, Matsutani S, Ohto M, Okuda K. Portal hemodynamics in patients with gastric varices. A study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology. 1988;95:434–40.

    Article  PubMed  CAS  Google Scholar 

  12. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102:2086–102.

    Article  PubMed  Google Scholar 

  13. de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.

    Article  PubMed  Google Scholar 

  14. Perry BC, Kwan SW. Portosystemic shunts: stable utilization and improved outcomes, two decades after the transjugular intrahepatic portosystemic shunt. J Am Coll Radiol. 2015;12:1427–33.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hosokawa I, Adam R, Allard MA, et al. Outcomes of surgical shunts and transjugular intrahepatic portasystemic stent shunts for complicated portal hypertension. Br J Surg. 2017;104:443–51.

    Article  PubMed  CAS  Google Scholar 

  16. Tan PC, Hou MC, Lin HC, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology. 2006;43:690–7.

    Article  PubMed  Google Scholar 

  17. Rios Castellanos E, Seron P, Gisbert JP, Bonfill Cosp X. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst Rev. 2015;12(5):CD010180.

    Google Scholar 

  18. Chang CJ, Hou MC, Liao WC, et al. Management of acute gastric varices bleeding. J Chin Med Assoc. 2013;76:539–46.

    Article  PubMed  CAS  Google Scholar 

  19. Irani S, Kowdley K, Kozarek R. Gastric varices: an updated review of management. J Clin Gastroenterol. 2011;45:133–48.

    Article  PubMed  Google Scholar 

  20. Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology. 2010;51:306.

    Article  PubMed  Google Scholar 

  21. Procaccini NJ, Al-Osaimi AM, Northup P, Argo C, Caldwell SH. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc. 2009;70:881–7.

    Article  PubMed  Google Scholar 

  22. Lo GH, Liang HL, Chen WC, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007;39:679–85.

    Article  PubMed  Google Scholar 

  23. Mahadeva S, Bellamy MC, Kessel D, Davies MH, Millson CE. Cost-effectiveness of N-butyl-2-cyanoacrylate (histoacryl) glue injections versus transjugular intrahepatic portosystemic shunt in the management of acute gastric variceal bleeding. Am J Gastroenterol. 2003;98:2688–93.

    Article  PubMed  CAS  Google Scholar 

  24. Saad WE. Vascular anatomy and the morphologic and hemodynamic classifications of gastric varices and spontaneous portosystemic shunts relevant to the BRTO procedure. Tech Vasc Interv Radiol. 2013;16:60–100.

    Article  PubMed  Google Scholar 

  25. Olson E, Yune HY, Klatte EC. Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices. AJR Am J Roentgenol. 1984;143:627–8.

    Article  PubMed  CAS  Google Scholar 

  26. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996;11:51–8.

    Article  PubMed  CAS  Google Scholar 

  27. Saad WE. The history and evolution of balloon-occluded retrograde transvenous obliteration (BRTO): from the United States to Japan and Back. Semin Interv Radiol. 2011;28:283–7.

    Article  Google Scholar 

  28. Lee EW, Saab S, Gomes AS, et al. Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of portal hypertensive variceal bleeding: preliminary results. Clin Transl Gastroenterol. 2014;5:e61.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gwon DI, Kim YH, Ko GY, et al. Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy: a prospective multicenter study. J Vasc Interv Radiol. 2015;26:1589–95.

    Article  PubMed  Google Scholar 

  30. Saad WE, Kitanosono T, Koizumi J, Hirota S. The conventional balloon-occluded retrograde transvenous obliteration procedure: indications, contraindications, and technical applications. Tech Vasc Interv Radiol. 2013;16:101–51.

    Article  PubMed  Google Scholar 

  31. Sabri SS, Swee W, Turba UC, et al. Bleeding gastric varices obliteration with balloon-occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam. J Vasc Interv Radiol. 2011;22:309–16; quiz 316.

    Article  PubMed  Google Scholar 

  32. Sabri SS, Abi-Jaoudeh N, Swee W, et al. Short-term rebleeding rates for isolated gastric varices managed by transjugular intrahepatic portosystemic shunt versus balloon-occluded retrograde transvenous obliteration. J Vasc Interv Radiol. 2014;25:355–61.

    Article  PubMed  Google Scholar 

  33. Chang MY, Kim MD, Kim T, et al. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage. Korean J Radiol. 2016;17:230–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Ron C. Gaba .

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Gaba, R.C., Mendoza-Elias, N., Schilling, J.H., Lipnik, A.J. (2018). Balloon-Occluded Transvenous Obliteration for Gastric Varices. In: Keefe, N., Haskal, Z., Park, A., Angle, J. (eds) IR Playbook. Springer, Cham. https://doi.org/10.1007/978-3-319-71300-7_39

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  • DOI: https://doi.org/10.1007/978-3-319-71300-7_39

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71299-4

  • Online ISBN: 978-3-319-71300-7

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