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J Vasc Interv Radiol. 2014 Mar;25(3):355-61. doi: 10.1016/j.jvir.2013.12.001. Epub 2014 Jan 24.

Short-term rebleeding rates for isolated gastric varices managed by transjugular intrahepatic portosystemic shunt versus balloon-occluded retrograde transvenous obliteration.

Author information

1
Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908. Electronic address: Ss2bp@virginia.edu.
2
Department of Diagnostic Radiology, National Institutes of Health, Bethesda, Maryland.
3
South Florida Vascular Associates, Coconut Creek, Florida.
4
Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908.
5
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.

Abstract

PURPOSE:

To 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 METHODS:

A 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.

RESULTS:

The 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).

CONCLUSIONS:

BRTO 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.

PMID:
24468043
DOI:
10.1016/j.jvir.2013.12.001
[Indexed for MEDLINE]

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