Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding.
- Author:
Geunwu GIMM
1
;
Young CHANG
;
Hyo Cheol KIM
;
Aesun SHIN
;
Eun Ju CHO
;
Jeong Hoon LEE
;
Su Jong YU
;
Jung Hwan YOON
;
Yoon Jun KIM
Author Information
- Publication Type:Original Article
- Keywords: Balloon-occluded retrograde transvenous obliteration; Portasystemic shunt, transjugular intrahepatic; Variceal bleeding
- MeSH: Ascites; Esophageal and Gastric Varices*; Hemorrhage; Hepatic Encephalopathy; Humans; Korea; Liver Cirrhosis; Odds Ratio; Pleural Effusion; Portasystemic Shunt, Surgical*; Portasystemic Shunt, Transjugular Intrahepatic; Retrospective Studies; Tertiary Care Centers
- From:Gut and Liver 2018;12(6):704-713
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Gastric varices (GVs) are a major cause of upper gastrointestinal bleeding in patients with liver cirrhosis. The current treatments of choice are balloon-occluded retrograde transvenous obliteration (BRTO) and the placement of a transjugular intrahepatic portosystemic shunt (TIPS). We aimed to compare the efficacy and outcomes of these two methods for the management of GV bleeding. METHODS: This retrospective study included consecutive patients who received BRTO (n=157) or TIPS (n=19) to control GV bleeding from January 2005 to December 2014 at a single tertiary hospital in Korea. The overall survival (OS), immediate bleeding control rate, rebleeding rate and complication rate were compared between patients in the BRTO and TIPS groups. RESULTS: Patients in the BRTO group showed higher immediate bleeding control rates (p=0.059, odds ratio [OR]=4.72) and lower cumulative rebleeding rates (log-rank p=0.060) than those in the TIPS group, although the difference failed to reach statistical significance. There were no significant differences in the rates of complications, including pleural effusion, aggravation of esophageal varices, portal hypertensive gastropathy, and portosystemic encephalopathy, although the rate of the progression of ascites was significantly higher in the BRTO group (p=0.02, OR=7.93). After adjusting for several confounding factors using a multivariate Cox analysis, the BRTO group had a significantly longer OS (adjusted hazard ratio [aHR]=0.44, p=0.01) and a longer rebleeding-free survival (aHR=0.34, p=0.001) than the TIPS group. CONCLUSIONS: BRTO provides better bleeding control, rebleeding-free survival, and OS than TIPS for patients with GV bleeding.
