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Published in: Emergency Radiology 3/2024

25-04-2024 | Esophageal Varices | Original Article

Is salvage Plug-Assisted Retrograde Transvenous Obliteration (PARTO) safe and effective for bleeding gastric varices ?- A preliminary single-center experience

Authors: Ranjan Kumar Patel, Taraprasad Tripathy, Manas Kumar Panigrahi, Hemant Kumar Nayak, Subash Chandra Samal, Bramhadatta Pattnaik, Tanmay Dutta, Sunita Gupta, Sudipta Mohakud, Suprava Naik, Nerbadyeswari Deep (Bag)

Published in: Emergency Radiology | Issue 3/2024

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Abstract

Background

Vascular plug-assisted retrograde transvenous obliteration (PARTO) obliterates the gastric varices and portosystemic shunt, thus resulting in a lower rebleeding rate than endoscopic glue/sclerotherapy.

Aims

To evaluate the safety and efficacy of PARTO as salvage therapy in liver cirrhosis with gastric variceal bleed (GVB) after failed endotherapy. We assessed the clinical success rate and changes in liver function at 6- months.

Materials and methods

Patients who underwent salvage PARTO after failed endotherapy for GVB (between December 2021 and November 2022) were searched and analyzed from the hospital database. Clinical success rate and rebleed rate were obtained at six months. Child–Pugh score (CTP) and Model for end-stage liver disease (MELD) score were calculated and compared between baseline and 6-month follow-up.

Results

Fourteen patients (n = 14, Child–Pugh class A/B) underwent salvage PARTO. Nine had GOV-2, and five had IGV-1 varices. The mean shunt diameter was 11.6 ± 1.6 mm. The clinical success rate of PARTO was 100% (no recurrent gastric variceal hemorrhage within six months). No significant deterioration in CTP (6.79 ± 0.98 vs. 6.21 ± 1.52; p = 0.12) and MELD scores (11.5 ± 4.05 vs. 10.21 ± 3.19; p = 0.36) was noted at 6 months. All patients were alive at 6 months. One patient (n = 1, 7.1%) bled from esophageal varices after three days of PARTO and was managed with variceal banding. 21.4% (3/14) patients had progression of esophageal varices at 6 months requiring prophylactic band ligation. Three patients (21.4%) had new onset or worsening ascites and responded to low-dose diuretics therapy.

Conclusions

PARTO is a safe and effective procedure for bleeding gastric varices without any deterioration in liver function even after six months. Patient selection is critical to prevent complications. Further prospective studies with larger sample size are required to validate our findings.
Literature
6.
go back to reference Mukund A, Rangarh P, Shasthry SM, Patidar Y, Sarin SK (2020) Salvage balloon occluded retrograde transvenous obliteration for gastric variceal bleed in cirrhotic patients with endoscopic failure to control bleed/very early rebleed: long-term outcomes. J Clin Exp Hepatol 10(5):421–428. https://doi.org/10.1016/j.jceh.2020.04.010 Mukund A, Rangarh P, Shasthry SM, Patidar Y, Sarin SK (2020) Salvage balloon occluded retrograde transvenous obliteration for gastric variceal bleed in cirrhotic patients with endoscopic failure to control bleed/very early rebleed: long-term outcomes. J Clin Exp Hepatol 10(5):421–428. https://​doi.​org/​10.​1016/​j.​jceh.​2020.​04.​010
7.
go back to reference Khera PS, Garg PK, Tiwari S, Bhargava N, Yadav T, Sureka B, Ghosh T, Babu S, Dadhich S, Singh S (2022) Retrograde transvenous obliteration of gastric varices using sodium tetradecyl sulphate: technical considerations and results from a single institution retrospective study. J Clin Intervent Radiol ISVIR 6(01):10–17CrossRef Khera PS, Garg PK, Tiwari S, Bhargava N, Yadav T, Sureka B, Ghosh T, Babu S, Dadhich S, Singh S (2022) Retrograde transvenous obliteration of gastric varices using sodium tetradecyl sulphate: technical considerations and results from a single institution retrospective study. J Clin Intervent Radiol ISVIR 6(01):10–17CrossRef
8.
go back to reference Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, Cohen AM, Midia M, Thornton RH, Gross K, Caplin DM, Aeron G, Misra S, Patel NH, Walker TG, Martinez-Salazar G, Silberzweig JE, Nikolic B (2017) Proposal of a new adverse event classification by the society of interventional radiology standards of practice committee. J Vasc Interv Radiol 28(10):1432–1437.e3. https://doi.org/10.1016/j.jvir.2017.06.019. Erratum in: J Vasc Interv Radiol. 2018 Jan;29(1):146 Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, Cohen AM, Midia M, Thornton RH, Gross K, Caplin DM, Aeron G, Misra S, Patel NH, Walker TG, Martinez-Salazar G, Silberzweig JE, Nikolic B (2017) Proposal of a new adverse event classification by the society of interventional radiology standards of practice committee. J Vasc Interv Radiol 28(10):1432–1437.e3. https://​doi.​org/​10.​1016/​j.​jvir.​2017.​06.​019. Erratum in: J Vasc Interv Radiol. 2018 Jan;29(1):146
11.
go back to reference Luo X, Xiang T, Wu J, Wang X, Zhu Y, Xi X, Yan Y, Yang J, García-Pagán JC, Yang L (2021) Endoscopic cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration for prevention of gastric variceal bleeding: a randomized controlled trial. Hepatology 74(4):2074–2084. https://doi.org/10.1002/hep.31718CrossRefPubMed Luo X, Xiang T, Wu J, Wang X, Zhu Y, Xi X, Yan Y, Yang J, García-Pagán JC, Yang L (2021) Endoscopic cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration for prevention of gastric variceal bleeding: a randomized controlled trial. Hepatology 74(4):2074–2084. https://​doi.​org/​10.​1002/​hep.​31718CrossRefPubMed
15.
go back to reference Yamamoto A, Nishida N, Morikawa H, Jogo A, Kageyama K, Sohgawa E, Hamamoto S, Takeshita T, Sakai Y, Matsuoka T, Kawada N, Miki Y (2016) Prediction for improvement of liver function after balloon-occluded retrograde transvenous obliteration for gastric varices to manage portosystemic shunt syndrome. J Vasc Interv Radiol 27(8):1160–1167. https://doi.org/10.1016/j.jvir.2016.03.031CrossRefPubMed Yamamoto A, Nishida N, Morikawa H, Jogo A, Kageyama K, Sohgawa E, Hamamoto S, Takeshita T, Sakai Y, Matsuoka T, Kawada N, Miki Y (2016) Prediction for improvement of liver function after balloon-occluded retrograde transvenous obliteration for gastric varices to manage portosystemic shunt syndrome. J Vasc Interv Radiol 27(8):1160–1167. https://​doi.​org/​10.​1016/​j.​jvir.​2016.​03.​031CrossRefPubMed
18.
go back to reference Mukund A, Choudhury SP, Tripathy TP, Ananthashayana VH, Jagdish RK, Arora V, Singh SP, Mishra AK, Sarin SK (2023) Influence of shunt occlusion on liver volume and functions in hyperammonemic cirrhosis patients having large porto-systemic shunts: a randomized control trial. Hepatol Int 17(1):150–158. https://doi.org/10.1007/s12072-022-10418-4. Erratum in: Hepatol Int. 2022 Dec;16(6):1496–1498 Mukund A, Choudhury SP, Tripathy TP, Ananthashayana VH, Jagdish RK, Arora V, Singh SP, Mishra AK, Sarin SK (2023) Influence of shunt occlusion on liver volume and functions in hyperammonemic cirrhosis patients having large porto-systemic shunts: a randomized control trial. Hepatol Int 17(1):150–158. https://​doi.​org/​10.​1007/​s12072-022-10418-4. Erratum in: Hepatol Int. 2022 Dec;16(6):1496–1498
19.
go back to reference Takuma Y, Morimoto Y, Takabatake H, Tomokuni J, Sahara A, Matsueda K, Yamamoto H (2020) Changes in liver and spleen stiffness by virtual touch quantification technique after balloon-occluded retrograde transvenous obliteration of gastric varices and exacerbation of esophageal varices: a preliminary study. Ultraschall Med 41(2):157–166. English. https://doi.org/10.1055/a-0731-0137 Takuma Y, Morimoto Y, Takabatake H, Tomokuni J, Sahara A, Matsueda K, Yamamoto H (2020) Changes in liver and spleen stiffness by virtual touch quantification technique after balloon-occluded retrograde transvenous obliteration of gastric varices and exacerbation of esophageal varices: a preliminary study. Ultraschall Med 41(2):157–166. English. https://​doi.​org/​10.​1055/​a-0731-0137
Metadata
Title
Is salvage Plug-Assisted Retrograde Transvenous Obliteration (PARTO) safe and effective for bleeding gastric varices ?- A preliminary single-center experience
Authors
Ranjan Kumar Patel
Taraprasad Tripathy
Manas Kumar Panigrahi
Hemant Kumar Nayak
Subash Chandra Samal
Bramhadatta Pattnaik
Tanmay Dutta
Sunita Gupta
Sudipta Mohakud
Suprava Naik
Nerbadyeswari Deep (Bag)
Publication date
25-04-2024
Publisher
Springer International Publishing
Published in
Emergency Radiology / Issue 3/2024
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI
https://doi.org/10.1007/s10140-024-02232-2

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