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CardioVascular and Interventional Radiology

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01-04-2014 | Review

Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

Authors: Wael E. Saad, Peter O. Simon Jr., Steven C. Rose

Published in: CardioVascular and Interventional Radiology | Issue 2/2014

Abstract

Balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices is an image-guided transcatheter procedure used to treat gastric varices with sclerosants rather than decompression of the portal venous system. The history of its development, relevant portal venous, and systemic venous anatomic considerations, techniques, indications, and early results will be reviewed. In addition, the status of the practice of BRTO in the United States will be discussed.

Saad WEA, Sabri SS (2011) BRTO: technical results and clinical outcomes. Semin Interv Radiol 28(3):333–338CrossRef

Ryan BM, Stockbrugger RW, Ryan MJ (2004) A pathologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology 126:1175–1189PubMedCrossRef

Sarin SK, Lahoti D, Saxena SP et al (1992) Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 16:1343–1349PubMedCrossRef

Fukuda T, Hirota S, Sugimura K (2001) Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol 12:327–336PubMedCrossRef

Saad WE, Al-Osaimi AM, Caldwell S et al (2012) For the Expert Panel on Interventional Radiology for the American College of Radiology. ACR appropriateness criteria: radiologic management of gastric varices. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Interventional/RadiologicManagementGastricVarices.pdf. Accessed 23 July 2012

Trudeau W, Prindiville T (1986) Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 32:264–268PubMedCrossRef

Korula J, Chin K, Ko Y, Yamada S (1991) Demonstration of two distinct subsets of gastric varices: observations during a seven-year study of endoscopic sclerotherapy. Dig Dis Sci 36:303–309PubMedCrossRef

Oho K, Iwao T, Sumino M et al (1995) Ethanolamine oleate versus butyl-cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy 27:349–354PubMedCrossRef

Kim HG, Han KH, Lee CY et al (1998) Outcome of endoscopic injection therapy of histoacryl in bleeding gastric varices. Gastroenterology 114:A1273

10.

Rockey DC (2001) Management of gastric varices. Gastroenterology 120:1875–1876PubMedCrossRef

11.

Kiyosue H, Mori H, Matsumoto S et al (2003) Transcatheter obliteration of gastric varices: part-1: anatomic classification. Radiographics 23:911–920PubMedCrossRef

12.

Kiyosue H, Mori H, Matsumoto S et al (2003) Transcatheter obliteration of gastric varices: part-2: strategy and techniques based on hemodynamic features. Radiographics 23:921–937PubMedCrossRef

13.

Ninoi T, Nishida N, Kaminou T et al (2005) Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. Am J Roentgenol 184:1340–1346CrossRef

14.

Hirota S, Matsumoto S, Tomita M et al (1999) Retrograde transvenous obliteration of gastric varices. Radiology 211:349–356PubMedCrossRef

15.

Knechtle SJ, Rikkers LF (2007) The place of portosystemic shunting. In: Blumgart LH, Belghiti J, DeMatteo RP, Chapman WC, Bucher WM, Hann LE, D’Angelica MD (eds) Surgery of the liver biliary tract, and pancreas, vol 2, 4th edn. Saunders, Elsevier, Philadelphia

16.

Henderson JM (2007) Distal splenorenal shunt. In: Blumgart LH, Belghiti J, DeMatteo RP, Chapman WC, Bucher WM, Hann LE, D’Angelica MD (eds) Surgery of the liver biliary tract, and pancreas, vol 2, 4th edn. Saunders, Elsevier, Philadelphia

17.

Kanagawa H, Mima S, Kouyama H et al (1996) Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 11:51–58PubMedCrossRef

18.

Hayashi S, Saeki S, Hosoi H et al (1998) A clinical and portal hemodynamic analysis for obliteration of gastric-renal shunt communicated with gastric fundic varices. Nippon Shakakibyo Gakkai Zasshi 95:755–763

19.

Tanihata H, Minamiguchi H, Sato M et al (2009) Changes in portal systemic pressure gradient after balloon-occluded retrograde transvenous obliteration of gastric varices and aggravation of esophageal varices. Cardiovasc Interv Radiol 32:1209–1216CrossRef

20.

Choi YS, Lee JH, Sinn DH et al (2008) Effect of balloon-occluded retrograde transvenous obliteration on the natural history of coexisting esophageal varices. J Clin Gastroenterol 42:974–979PubMedCrossRef

21.

Nakamura S, Torii N, Yatsuji S et al (2008) Long-term follow-up of esophageal varices after balloon-occluded retrograde transvenous obliteration for gastric varices. Hepatol Res 38:340–347PubMedCrossRef

22.

Furano AH, Ring EJ, Freiman DB, Oleaga JA et al (1979) Transhepatic obliteration of esophageal varices using the stainless steel coil. Am J Roentgenol 133:1123–1125CrossRef

23.

Scott J, Dick R, Long RG et al (1976) Percutaneous transhepatic obliteration of gastro-osephageal varices. Lancet 10:53–55CrossRef

24.

Lunderquist A, Simert G, Tylen U et al (1977) Follow-up of patients with portal hypertension and esophageal varices treated with percutaneous obliteration of gastric coronary vein. Radiology 122:59–63PubMed

25.

Lunderquist A, Vang J (1974) Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices. N Engl J Med 291:646–649PubMedCrossRef

26.

Lunderquist A, Vang J (1974) Sclerosing injection of esophageal varices through transhepatic selective catheterisation of the gastric coronary vein: a preliminary report. Acta Radiol Diagn (Stockh) 15:546–550

27.

Olson E, Yune HY, Klatte EC (1984) Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices. Am J Roentgenol 143:627–628CrossRef

28.

Kanagawa H, Mima S, Kouyama H et al (1991) A successful case of fundic varices by retrograde transvenous obliteration with balloon. Nippon Shokakibyo Gakkai Zasshi 88:1452–1462

29.

Yamagami T, Kato T, Hirota T et al (2007) Infusion of 50% glucose solution before injection of ethanolamine oleate during balloon-occluded retrograde transvenous obliteration. Aust Radiol 51:334–338CrossRef

30.

Kitamoto M, Imamura M, Kamada K et al (2002) Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. Am J Roentgenol 178:1167–1174CrossRef

31.

Ninoi T, Nakamura K, Kaminou T et al (2004) TIPS versus transcatheter sclerotherapy for gastric varices. Am J Roentgenol 183:369–376CrossRef

32.

Akahoshi T, Hashizume M, Tomikawa M et al (2008) Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience. Gastroenterology 23:1702–1709

33.

Sonomura T, Sato M, Kishi K et al (1998) Balloon-occluded retrograde transvenous obliteration for gastric varices: a feasibility study. Cardiovasc Interv Radiol 21:27–30CrossRef

34.

Kiyosue H, Matsumoto S, Onishi R et al (1999) Balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices: therapeutic results and problems. Nippon Igaku Hoshasen Gakkai Zasshi 59:12–19PubMed

35.

Koito K, Namieno T, Nagakawa T et al (1996) Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. Am J Roentgenol 167:1317–1320CrossRef

36.

Chikamori F, Kuniyoshi N, Kawashima T et al (2008) Gastric varices with gastrorenal shunt: combined therapy using transjugular retrograde obliteration and partial splenic embolization. Am J Roengenol 191:555–559CrossRef

37.

Kumamoto M, Toyonaga A, Inoue H et al (2010) Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol 25:1129–1135PubMedCrossRef

38.

Chikamori F, Kuniyoshi N, Shibuya S et al (2000) Transjugular retrograde obliteration for chronic portosystemic encephalopathy. Abdom Imaging 25:567–571PubMedCrossRef

39.

Chikamori F, Kuniyoshi N, Shibuya S et al (2004) Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices. Hepatogastroenterology 51:1379–1381PubMed

40.

Chikamori F, Kuniyoshi N, Shibuya S et al (2001) Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery 129:414–420PubMedCrossRef

41.

Miyamoto Y, Oho K, Kumamoto M, Toyonaga A et al (2003) Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension. J Gastroenterol Hepatol 18:934–942PubMedCrossRef

42.

Sugimori K, Morimoto M, Shirato K et al (2005) Retrograde transvenous obliteration of gastric varices associated with large collateral veins or a large gastrorenal shunt. J Vasc Intrev Radiol 16:113–118CrossRef

43.

Fukuda T, Hirota S, Matsumoto S et al (2004) Application of balloon-occluded retrograde transvenous obliteration to gastric varices complicating refractory ascites. Cardiovasc Interv Radiol 27:64–67

44.

Shimoda R, Horiuchi K, Hagiwara S et al (2005) Short-term complications of balloon-occluded retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging 30:306–313PubMedCrossRef

45.

Takuma Y, Nouso K, Makino Y et al (2005) Prophylactic balloon-occluded retrograde transvenous obliteration for gastric varices in compensated cirrhosis. Clin Gastroenterol Hepatol 3:1245–1252PubMedCrossRef

46.

Arai H, Abe T, Takagi H et al (2006) Efficacy of balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices. World J Gastroenterol 12:3866–3873PubMed

47.

Arai H, Abe T, Shimoda R et al (2005) Emergency balloon-occluded retrograde transvenous obliteration for gastric fundal varices. J Gastroenterol 40:964–971PubMedCrossRef

48.

Matsumoto A, Hamamoto N, Nomura T et al (1999) Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices. Am J Gastroenterol 94:643–649PubMedCrossRef

49.

Fukuda T, Hirota S, Sugimoto K et al (2005) “Downgrading” of gastric varices with multiple collateral veins in balloon-occluded retrograde transvenous obliteration. J Vasc Interv Radiol 16:1379–1383PubMedCrossRef

50.

Park KS, Kim YH, Choi JS et al (2006) Therapeutic efficacy of balloon-occluded retrograde transvenous obliteration in patients with gastric variceal bleeding. Korean J Gastroenterol 47:370–378PubMed

51.

Kim ES, Park SY, Kwon KT et al (2003) The clinical usefulness of balloon-occluded retrograde transvenous obliteration in gastric variceal bleeding. Teehan Kan Hakhoe Chi 9:315–323

52.

Park SJ, Chung JW, Kim H-C et al (2010) The prevalence, risk factors, and clinical outcome of balloon rupture in balloon-occluded retrograde transvenous obliteration of gastric varices. J Vasc Interv Radiol 21:503–507PubMedCrossRef

53.

Hong CH, Kim HJ, Park JH et al (2009) Treatment of patients with gastric variceal hemorrhage: endoscopic n-butyl-2cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 24:372–378PubMedCrossRef

54.

Cho SK, Shin SW, Lee IH et al (2007) Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. Am J Roentgenol 189:W365–W372CrossRef

55.

Choi YH, Yoon CJ, Park JH et al (2003) Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt (TIPS). Korean J Radiol 4:109–116PubMedCentralPubMedCrossRef

56.

Ferral H, Gamboa P, Postoak DW et al (2004) Survival after elective transjugular intrahepatic portosystemic shunt (TIPS) creation: prediction with model for end stage liver disease (MELD) score. Radiology 231:231–236PubMedCrossRef

57.

Ferral H, Patel NH (2005) Selection criteria for patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures: current status. J Vasc Interv Radiol 26:449–455CrossRef

58.

Montgomery A, Ferral H, Vasan R et al (2005) MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures. Cardiovasc Interv Radiol 28:307–312CrossRef

59.

Anderson C, Saad WE, Kalagher S et al (2010) Effect of transjugular intrahepatic portosystemic shunt (TIPS) placement on renal function: a 7-year, single-center experience. J Vasc Interv Radiol 21:1370–1376PubMedCrossRef

60.

Saad WE (2011) The history and evolution of balloon-occluded retrograde transvenous obliteration (BRTO): from the United States to Japan and back. Semin Interv Radiol 28(3):283–287CrossRef

61.

Ono S, Irie T, Kuramochi M et al (2007) Successful treatment of mesenteric varices with balloon-occluded retrograde transvenous obliteration via an abdominal wall vein. J Vasc Interv Radiol 18:1033–1035PubMedCrossRef

62.

Nakai M, Sato M, Sahara S et al (2006) Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt. World J Gastroenterol 21:5071–5074

63.

Tajiri T, Onda M, Yamashita K et al (1996) Interventional radiology for portal hypertension: PTO and TIO. Nippon Geka Gakkai Zasshi 97:70–77PubMed

64.

Sonomora T, Sahara S, Ono W et al (2011) Usefulness of microcatheter inserted overnight for additional injection of sclerosant after initial balloon-occluded retrograde transvenous obliteration of gastric varices. Case Rep Gastroenterol 5:534–539CrossRef

65.

Araki T, Hori M, Motosugi U et al (2010) Can balloon-occluded retrograde transvenous obliteration be performed for gastric varices without gastrorenal shunts? J Vasc Interv Radiol 21:663–670PubMedCrossRef

66.

Saad WE (2013) Vascular anatomy and the morphologic and hemodynamic classification of gastric varices and spontaneous portosystemic shunts relevant to the BRTO-procedure. Tech Vasc Interv Radiol 17 (in press)

67.

Saad WE, Hirota S, Kitanosono T (2013) The Conventional balloon-occluded retrograde transvenous obliteration (BRTO) procedure: indications, contraindications and technical considerations. Tech Vasc Interv Radiol (in press)

68.

Saad WE, Nicholson LippertA et al (2012) Balloon occlusion catheter rupture during balloon-occluded retrograde transvenous obliteration of gastric varices utilizing sodium tetradecyl sulfate: incidence and consequences. Vasc Endovascular Surg 46:664–670PubMedCrossRef

69.

Saad WE, Sze DH (2011) Variations of balloon-occluded transvenous obliteration (BRTO): balloon-occluded antegrade transvenous obliteration (BATO) and alternative/adjunctive routes for BRTO. Semin Interv Radiol 28:314–324CrossRef

70.

Saad WE, Nicholson D, Koizumi J (2012) Inventory used for balloon-occluded retrograde (BRTO) and antegrade (BATO) tranvenous obliteration (BRTO): sclerosants and balloon-occlusion devices. Tech Vasc Interv Radiol 15:226–240PubMedCrossRef

71.

Sabri SS, Swee W, Turba UC et al (2010) Bleeding gastric varices obliteration with balloon-occluded retrograde transvenous obliteration (BRTO) utilizing sodium TetraDecyl sulfate foam. J Vasc Interv Radiol 3:309–316

72.

Saad WEA, Al-Ossaimi AM, Caldwell S (2012) Pre- and Post-BRTO imaging and clinical evaluation: indications, management protocols and follow-up. Tech Vasc Interv Radiol 15:165–202PubMedCrossRef

73.

Saad WEA, Darcy MD (2011) Transjugular intrahepatic portosystemic shunt (TIPS) versus balloon-occluded retrograde transvenous obliteration (BRTO) for management of gastric varices. Semin Interv Radiol 28(3):339–349CrossRef

74.

Hassab MA (1967) Gastroesophageal decongestion and splenectomy in the treatment of esophageal varices in bilharzial cirrhosis: further studies with a report of 355 operations. Surgery 61:169–176PubMed

75.

Kameda N, Higuchi K, Shiba M et al (2008) Management of gastric fundal varices without gastro-renal shunt in 15 patients. World J Gastroenterol 14:448–453PubMedCentralPubMedCrossRef

76.

Araki T, Saad WEA (2012) Balloon-occluded retrograde transvenous obliteration of gastric varices from unconventional systemic veins in the absence of gastrorenal shunts. Tech Vasc Interv Radiol 15:241–253PubMedCrossRef

77.

Al-Osaimi AM, Caldwell SH (2011) Medical and endoscopic management of gastric varices. Semin Interv Radiol 28:273–282CrossRef

78.

Sarin SK, Kumar A (1989) Gastric varices: profile, classification and management. Am J Gastroenterol 84:1244–1249PubMed

79.

Sarin SK (1997) Long-term follow-up of gastric variceal sclerotherapy: an eleven year experience. Gastrointest Endosc 46:8–14PubMedCrossRef

80.

Jutabha R, Jensen DM, Kovacs TO et al (1998) Initial results of a prospective study of combination banding and sclerotherapy compared to sclerotherapy alone for the bleeding gastric varices. Gastrointest Endosc 47:AB86

81.

Lo GH, Lai KH, Cheng JS et al (2001) A prospective, randomized trial of butyl cyanoacrylate injection verus band ligation in the management of bleeding gastric varices. Hepatology 33:1060–1064PubMedCrossRef

82.

Tan PC, Hou MC, Lin HC et al (2006) A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: n-butyl-2-cyanoacrylate injection versus band ligation. Hepatology 43:690–697PubMedCrossRef

83.

Mahadeva S, Bellamy MC, Kessel D et al (2003) Cost-effectiveness of N-butyl-2-cyanoacrylate (histoacryl) glue injections versus transjugular intrahepatic portosystemic shunt in the management of gastric variceal bleeding. Am J Gastroenterol 98:2688–2693PubMedCrossRef

84.

Procaccini NJ, Al-Osaimi AM, Northup P et al (2008) Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center US analysis. Gastrointest Endosc 68:877–882CrossRef

85.

Lo GH, Liang HL, Chen WC et al (2007) A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 39:679–685PubMedCrossRef

86.

Barange K, Peron JM, Imani K et al (1999) Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology 30:1139–1143PubMedCrossRef

87.

Chau TN, Patch DN, Chan YW et al (1998) “Salvage” transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology 114:981–987PubMedCrossRef

88.

Rees CJ, Nylander DL, Thompson NP et al (2000) Do gastric and esophageal varices bleed at different portal pressures and is TIPS an effective treatment? Liver 20:253–256PubMedCrossRef

89.

Saad WE, Wagner C, Lippert A et al (2013) Protective value to TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration (BRTO). Am J Gastroenterol. doi:10.1038/ajg.2013.232

Title: Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices
Authors: Wael E. Saad
Peter O. Simon Jr.
Steven C. Rose
Publication date: 01-04-2014
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 2/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-013-0715-y

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Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

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