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

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.

• Authors: Shin Jae Lee, Seung Up Kim, Man-Deuk Kim, Young Hwan Kim, Gyoung Min Kim, Sung Il Park, Jong Yun Won, Do Yun Lee, Kwang-Hun Lee
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 32 Issue 8 Pg. 1487-1494 (Aug 2017) ISSN: 1440-1746 [Electronic] Australia
• PMID: 28085232 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Topics

• Aged
• Balloon Occlusion (methods)
• Esophageal and Gastric Varices (complications)
• Female
• Gastrointestinal Hemorrhage (etiology, therapy)
• Hemostasis, Surgical (methods)
• Hepatitis B (complications)
• Hepatitis C (complications)
• Humans
• Liver Cirrhosis, Alcoholic (complications)
• Male
• Middle Aged
• Portasystemic Shunt, Transjugular Intrahepatic (methods)
• Retrospective Studies
• Treatment Outcome