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J Gastroenterol Hepatol. 2017 Aug;32(8):1487-1494. doi: 10.1111/jgh.13729.

Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis.

Author information

1
Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
2
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
3
Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
4
Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
5
Department of Radiology, Gangam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND AIM:

Both balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB.

METHODS:

A total of 142 patients undergoing BRTO (n = 95) or TIPS (n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review.

RESULTS:

Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause (n = 63, 44.4%), followed by hepatitis B (n = 60, 42.3%) and hepatitis C (n = 7, 4.9%) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1%) patients. During the follow-up period (mean, 28.2 months), 27 patients (19%) experienced re-bleeding. Cumulative re-bleeding rates after BRTO (8.6% at 1 year; 22.7% at 3 years) were significantly lower than those after TIPS (19.8% at 1 year; 48.2% at 3 years; P = 0.006, log-rank test). In multivariate analysis, TIPS (vs BRTO) was found independently predictive of re-bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child-Pugh score (both P < 0.05). Although BRTO surpassed TIPS (P = 0.026, log-rank test) in terms of overall postprocedural survival, independent factors predictive of poor overall survival after hemostasis were concurrent HCC (HR = 3.106), high Child-Pugh score (HR = 1.886 per 1-point increase), and postprocedural hepatic encephalopathy (HR = 3.014; all P < 0.05).

CONCLUSION:

Balloon-occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re-bleeding.

KEYWORDS:

balloon-occluded retrograde transvenous obliteration; gastric variceal bleeding; outcome; overall survival; re-bleeding; transjugular intrahepatic portosystemic shunt

PMID:
28085232
DOI:
10.1111/jgh.13729
[Indexed for MEDLINE]

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