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CardioVascular and Interventional Radiology

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01-10-2014 | Clinical Investigation

Risk Factors for Rebleeding and Prognostic Factors for Postoperative Survival in Patients with Balloon-Occluded Retrograde Transvenous Obliteration of Acute Gastric Variceal Rupture

Authors: Ken Kageyama, Norifumi Nishida, Akira Yamamoto, Atsushi Jogo, Shinichi Hamamoto, Hiroto Matsui, Masahiro Tokunaga, Yukio Miki

Published in: CardioVascular and Interventional Radiology | Issue 5/2014

Abstract

Purpose

Balloon-occluded retrograde transvenous obliteration (B-RTO) has shown great potential in controlling acute gastric variceal hemorrhage, although rebleeding related to the procedure may occur in a small percentage of patients. The purpose of this study was to identify risk factors of perioperative rebleeding and prognostic factors of postoperative survival in B-RTO performed for acute episodes of gastric variceal hemorrhage.

Methods

We retrospectively analyzed 39 consecutive patients who underwent B-RTO for gastric variceal rupture at our hospital between June 2003 and May 2011. Uni- and multi-variate analyses were performed to assess risk factors for perioperative rebleeding and prognostic factors for postoperative survival.

Results

Surgical success and complete eradication of varices were achieved in 36 cases (92.3 %) and 35 cases (89.7 %), respectively. Six patients experienced rebleeding either intraoperatively (n = 3) or within 1 h after B-RTO (n = 3). Child-Pugh class C was identified as a risk factor for rebleeding on univariate (P = 0.018) and multivariate analyses (odds ratio, 6.003; P = 0.014). With a median follow-up of 23 months (range 0–106.6 months), overall survival rates at 1, 3, and 5 years were 91.7, 74.7, and 67.2 %, respectively. Multivariate analyses revealed Child-Pugh class C as a prognostic factor for survival (relative risk, 4.014; P = 0.023).

Conclusion

Although B-RTO is generally effective in the treatment of acute gastric variceal rupture, patients classified as Child-Pugh class C have a higher risk of perioperative rebleeding and shorter survival.

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

Watanabe K, Kimura K, Matsutani S et al (1988) Portal hemodynamics in patients with gastric varices. A study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology 95:434–440PubMed

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

Sarin SK, Sachdev G, Nanda R et al (1988) Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg 75:747–750PubMedCrossRef

Fleig WE, Stange EF, Ruettenauer K, Ditschuneit H (1983) Emergency endoscopic sclerotherapy for bleeding esophageal varices: prospective study in patients not responding to balloon tamponade. Gastrointest Endosc 29:8–14PubMedCrossRef

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

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. AJR Am J Roentgenol 184:1340–1346PubMedCrossRef

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. J Gastroenterol Hepatol 23:1702–1709PubMedCrossRef

Hiraga N, Aikata H, Takaki S et al (2007) The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol 42:663–672PubMedCrossRef

10.

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

11.

Akahoshi T, Tomikawa M, Kamori M et al (2012) Impact of balloon-occluded retrograde transvenous obliteration on management of isolated fundal gastric variceal bleeding. Hepatol Res 42:385–393PubMedCrossRef

12.

Kim T, Shijo H, Kokawa H et al (1997) Risk factors for hemorrhage from gastric fundal varices. Hepatology 25:307–312PubMedCrossRef

13.

Japan Society for Portal Hypertension (2004) The general rules for study of portal hypertension, 2nd edn. Kanehara, Tokyo

14.

Paik CN, Kim SW, Lee IS et al (2008) The therapeutic effect of cyanoacrylate on gastric variceal bleeding and factors related to clinical outcome. J Clin Gastroenterol 42:916–922PubMedCrossRef

15.

Abdel-Wahab OI, Healy B, Dzik WH (2006) Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities. Transfusion 46:1279–1285PubMedCrossRef

16.

Hashizume M, Akahoshi T, Tomikawa M (2011) Management of gastric varices. J Gastroenterol Hepatol 26(suppl 1):102–108PubMedCrossRef

17.

Akahoshi T, Hashizume M, Shimabukuro R et al (2002) Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience. Surgery 131(1 suppl):S176–S181PubMedCrossRef

18.

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

19.

Huang YH, Yeh HZ, Chen GH et al (2000) Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety. Gastrointest Endosc 52:160–167PubMedCrossRef

20.

D’Imperio N, Piemontese A, Baroncini D et al (1996) Evaluation of undiluted N-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Endoscopy 28:239–243PubMedCrossRef

21.

Kind R, Guglielmi A, Rodella L et al (2000) Bucrylate treatment of bleeding gastric varices: 12 years’ experience. Endoscopy 32:512–519PubMedCrossRef

22.

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

23.

Tripathi D, Therapondos G, Jackson E et al (2002) The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations. Gut 51:270–274PubMedCentralPubMedCrossRef

24.

Saxon RS, Ross PL, Mendel-Hartvig J et al (1998) Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. Radiology 207:683–693PubMedCrossRef

25.

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

26.

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

27.

Song HG, Lee HC, Park YH et al (2002) Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices. Taehan Kan Hakhoe Chi 8:448–457PubMed

28.

LaBerge JM, Somberg KA, Lake JR et al (1995) Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: results in 90 patients. Gastroenterology 108:1143–1151PubMedCrossRef

29.

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

30.

Uehara H, Akahoshi T, Tomikawa M et al (2012) Prediction of improved liver function after balloon-occluded retrograde transvenous obliteration: relation to hepatic vein pressure gradient. J Gastroenterol Hepatol 27:137–141PubMedCrossRef

31.

Zhang HB, Wong BC, Zhou XM et al (2002) Effects of somatostatin, octreotide and pitressin plus nitroglycerine on systemic and portal haemodynamics in the control of acute variceal bleeding. Int J Clin Pract 56:447–451PubMed

32.

Garcia-Tsao G, Bosch J (2010) Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 362:823–832PubMedCrossRef

33.

Moitinho E, Escorsell A, Bandi JC et al (1999) Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology 117:626–631PubMedCrossRef

Title: Risk Factors for Rebleeding and Prognostic Factors for Postoperative Survival in Patients with Balloon-Occluded Retrograde Transvenous Obliteration of Acute Gastric Variceal Rupture
Authors: Ken Kageyama
Norifumi Nishida
Akira Yamamoto
Atsushi Jogo
Shinichi Hamamoto
Hiroto Matsui
Masahiro Tokunaga
Yukio Miki
Publication date: 01-10-2014
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 5/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-013-0807-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk Factors for Rebleeding and Prognostic Factors for Postoperative Survival in Patients with Balloon-Occluded Retrograde Transvenous Obliteration of Acute Gastric Variceal Rupture

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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