| 1. Sharma BC, Varakanahalli S, Singh JP, Srivastava S. Gastric Varices in Cirrhosis vs. Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-butyl-2-cyanoacrylate Injection. J Clin Exp Hepatol. 2017;7(2):97-101. |
Observational-Tx |
454 patients. |
To compare the types of gastric varices (GV) in cirrhosis vs. extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection. |
Of 454 patients, 64% (n = 292) were cirrhotics and 36% (n = 162) had EHPVO. Types of GV were GOV1 in 16.4% (n = 48) of cirrhotics vs. 7.4% (n = 12) of EHPVO, GOV2 in 76.7% (n = 224) of cirrhotics vs. 53.1% (n = 86) of EHPVO, Isolated gastric Varices (IGV1) in 39.5% (n = 64) of patients with EHPVO vs. 6.8% (n = 20) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 2.89 +/- 1.59 ml over a median of 1 session (range: 1-7). The total volume of glue required was lower in cirrhotics (2.44 +/- 1.17 ml vs. 3.69 +/- 1.91 ml, P < 0.05) than in EHPVO patients. One hundred and seventeen (40.1%) of cirrhotics required >1 sessions of glue injection as compared to 102 (63%) of EHPVO patients. Over mean follow up of 14.7 +/- 6.46 months, rebleeding (10% vs. 13%) was similar in patients with cirrhosis and EHPVO and mortality (15.4% vs. 2.5%) was higher in cirrhotics than EHPVO. |
2 |
| 2. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65(1):310-335. |
Review/Other-Dx |
N/A |
To provide a data-supported approach to risk stratification, diagnosis, and management of patients with cirrhosis and portal hypertension (PH). |
No results stated in abstract. |
4 |
| 3. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343-1349. |
Review/Other-Tx |
N/A |
To determine the prevalence and natural history of gastric varices. |
Type 1 gastroesophageal varices (lesser curve varices) were the most common (75%). After obliteration of esophageal varices, type 1 gastroesophageal varices disappeared in 59% of pateints and persisted in the remainder; bleeding from perisistent gastroesophageal varices was more common than it was from gastroesophageal varices that were obliterated (28% vs. 2%, respectively; p < 0.001). |
4 |
| 4. Deng H, Qi X, Guo X. Computed tomography for the diagnosis of varices in liver cirrhosis: a systematic review and meta-analysis of observational studies. [Review]. Postgrad Med. 129(3):318-328, 2017 Apr. |
Meta-analysis |
17 studies |
To evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) for varices in liver cirrhosis. |
The AUSROC was 0.8975 and 0.9494 for predicting any size and high-risk varices, respectively. Summary sensitivity, specificity, PLR, NLR, and DOR of CT for predicting any size and high-risk varices were 0.87/0.80/3.67/0.18/22.70 and 0.87/0.88/7.52/0.12/65.55, respectively. According to the location of varices, the AUSROC was 0.9127 for predicting any size gastric varices alone; and the AUSROC was 0.8958 and 0.9461 for predicting any size and high-risk esophageal varices alone, respectively. According to the CT technique, the AUSROC of multi-detector CT (MDCT) was 0.9047 and 0.9490 for predicting any size and high-risk varices, respectively; and the AUSROC of MDCT esophagograms for predicting any size and high-risk varices was 0.8735 and 0.9664, respectively. In the subgroup analysis of prospective studies, the AUSROC was 0.9122 and 0.9507 for predicting any size and high-risk varices, respectively. |
Good |
| 5. Zhu K, Meng X, Pang P, et al. Gastric varices in patients with portal hypertension: evaluation with multidetector row CT. J Clin Gastroenterol. 2010;44(5):e108-115. |
Observational-Dx |
127 patients |
To assess the diagnostic performance of MDCT in detecting GVs and revealing variceal hemodynamic changes in patients with cirrhosis. |
On the basis of EGD, of the 127 patients, 36 had GVs (28.4%), including small GVs in 15 patients and large GVs (>or=5 mm) in 21 patients. In detecting and grading GVs, there were moderate agreements (kappa value: 0.514 to 0.563) between MDCT and EGD, but in differentiating large varices requiring prophylactic therapy, a substantial agreement (kappa value: 0.804 for radiologist 1 and 0.796 for radiologist 2) was found. For radiologist 1, the sensitivity, specificity, accuracy, and positive and negative predictive values of MDCT for the identification of large GVs were 85.7%, 96.2%, 94.5%, 81.8%, and 97.1%, respectively; whereas for radiologist 2, they were 81.0%, 97.2%, 94.5%, 85.0%, and 96.3%, respectively. In evaluating the afferent and efferent veins of varices, the sensitivity, specificity, accuracy, and positive predictive value of MDCT portography were more than 80.0%. |
3 |
| 6. Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004;126(4):1175-1189. |
Review/Other-Tx |
N/A |
To describe the pathophysiology, diagnosis, natural history, endoscopic, and interventional radiologic treatment options for gastric varices. |
First-line treatment of bleeding fundal varices is endoscopic variceal obturation: TIPS is currently second-line acute treatment and is used for prevention of rebleeding. |
4 |
| 7. Sarin SK. Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience. Gastrointest Endosc. 1997;46(1):8-14. |
Observational-Tx |
209 patients |
To analyze the role of endoscopy in the management of gastric variceal bleeding through the treatment of gastric varices and the identification of their respective management strategies. |
Emergency gastric variceal sclerotherapy arrested acute bleeding in 12 (66.7%) of 18 patients. Variceal obliteration was achieved in 43 of the 60 (71.6%) patients who underwent repeated elective sclerotherapy. Variceal obliteration was higher in patients with GOV1 (94.4%) than in those with GOV2 (70.4%) and IGV1 (41%). Rebleeding after elective gastric variceal sclerotherapy was seen in 5.5%, 19%, and 53%, respectively, in the three types of gastric varices. Gastric variceal recurrence was not seen during a mean follow-up of 24.2 +/- 22.9 months. Seventeen (24%) patients died, nearly equally from rebleeding and liver failure. |
2 |
| 8. Qiao W, Ren Y, Bai Y, Liu S, Zhang Q, Zhi F. Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement. Medicine (Baltimore). 2015;94(41):e1725. |
Meta-analysis |
3 RCTs: 194 patients |
To help guide endoscopic decisions regarding acute gastric variceal bleeding, a meta-analysis was conducted to evaluate bleeding control, blood transfusion, rebleeding, recurrence of varices, complications, and survival. |
Active bleeding control was achieved in 46 of 49 (93.9%) patients in the cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14-17.30). Rebleeding rate was comparable in type 2 gastroesophageal varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015). Cyanoacrylate injection was also superior in controlling recurrence of gastric varices to band ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. |
Good |
| 9. Kuramochi A, Imazu H, Kakutani H, Uchiyama Y, Hino S, Urashima M. Color Doppler endoscopic ultrasonography in identifying groups at a high-risk of recurrence of esophageal varices after endoscopic treatment. J Gastroenterol 2007;42:219-24. |
Observational-Dx |
68 patients |
To demonstrate that either a high hepatofugal flow velocity in the left gastric vein (LGV) or an anterior branch dominant pattern seen under color Doppler EUS (CD-EUS) were possible contributing risk factors for variceal recurrence after endoscopic treatment. |
Half of the patients in the high-risk group exhibited a recurrence within half a year, whereas it took almost 2 years for half of the patients in the other group to exhibit a recurrence (P=0.0044). Using the Cox proportional hazard model with multivariate analysis, only the features of the high-risk group were significant in triggering recurrence of varices (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.35-6.65; P<0.001). |
3 |
| 10. Dariushnia SR, Haskal ZJ, Midia M, et al. Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts. J Vasc Interv Radiol. 2016;27(1):1-7. |
Review/Other-Tx |
N/A |
To reflect the foregoing points while emphasizing the current literature and outcomes. |
No results stated in abstract. |
4 |
| 11. Holster IL, Tjwa ET, Moelker A, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + beta-blocker for prevention of variceal rebleeding. Hepatology. 2016;63(2):581-589. |
Experimental-Tx |
72 patients |
To compare long-term endoscopic variceal ligation (EVL) or glue injection + beta-blocker treatment with TIPS placement in 72 patients with a first or second episode of gastric and/or esophageal variceal bleeding, after hemodynamic stabilization upon endoscopic, vasoactive, and antibiotic treatment. |
During a median follow-up of 23 months, 10 (29%) of 35 patients in the endoscopy + beta-blocker group, as compared to 0 of 37 (0%) patients in the TIPS group, developed variceal rebleeding (P = 0.001). Mortality (TIPS 32% vs. endoscopy 26%; P = 0.418) and treatment failure (TIPS 38% vs. endoscopy 34%; P = 0.685) did not differ between groups. Early hepatic encephalopathy (within 1 year) was significantly more frequent in the TIPS group (35% vs. 14%; P = 0.035), but during long-term follow-up this difference diminished (38% vs. 23%; P = 0.121). |
1 |
| 12. Perarnau JM, Le Gouge A, Nicolas C, et al. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol. 2014;60(5):962-968. |
Experimental-Tx |
137 patients |
To compare the primary patency of TIPS performed with covered stents (CS) and bare stents (BS). |
137 patients were randomized: 66 to receive CS, and 71 BS. Patients who were found to have a hepato-cellular carcinoma, or whose procedure was cancelled were excluded, giving a sample of 129 patients (62 vs. 67). Median follow-up for CS and BS were 23.6 and 21.8months, respectively. Compared to BS, the risk of TIPS dysfunction with CS was 0.60 95% CI [0.38-0.96], (p=0.032). The 2-year rate of shunt dysfunction was 44.0% for CS vs. 63.6% for BS. Early post TIPS complications (22.4% vs. 34.9%), risk of hepatic encephalopathy (0.89 [0.53-1.49]) and 2-year survival (70% vs. 67.5%) did not differ in the two groups. The 2-year cost/patient was 20keuro [15.9-27.5] for CS vs. 23.4keuro [18-37] for BS (p=0.52). |
1 |
| 13. Barange K, Peron JM, Imani K, et al. Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology. 1999;30(5):1139-1143. |
Review/Other-Tx |
32 patients |
To report the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory gastric variceal bleeding. |
Hemostasis was achieved in 18 out of 20 patients actively bleeding at the time of the procedure. In the whole sample of 32 patients, rebleeding rates were 14%, 26%, and 31%, respectively at 1 month, 6 months, and 1 year. De novo encephalopathy was observed in 5 (16%) patients. Seven patients experienced complications and consequently 4 of these patients died. TIPS primary patency rates were 84%, 74%, and 51%, respectively, at 1 month, 6 months, and 1 year. For the same periods of time, survival rates were 75%, 62%, and 59%. These results suggest that TIPS can be used in cirrhotic patients with refractory gastric variceal bleeding and are effective in achieving hemostasis as well as in preventing rebleeding. |
4 |
| 14. Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK. "Salvage" transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology. 1998;114(5):981-987. |
Observational-Tx |
115 patients |
To compare the efficacy of transjugular intrahepatic portosystemic stent/shunt (TIPS) in patients with uncontrolled gastric fundal vs. esophageal variceal bleeding. |
Variceal bleeding was controlled in all patients after TIPS except for 1 in each group. There were no significant differences between the two groups in terms of markers of disease severity, severity of bleeding, or portal hemodynamics. During a median follow-up period of 7 months, 20 in the EV group (24%) and 8 in the GV group (29%) developed clinical rebleeding. Most early rebleeding (within 7 days after TIPS) was related to esophageal ulceration secondary to previous sclerotherapy. Rates of mortality were similar in both groups. |
2 |
| 15. Choi YH, Yoon CJ, Park JH, Chung JW, Kwon JW, Choi GM. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt. Korean J Radiol. 2003;4(2):109-116. |
Experimental-Tx |
21 patients |
To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). |
One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02). |
1 |
| 16. Kim SK, Lee KA, Sauk S, Korenblat K. Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices. Korean J Radiol. 18(2):345-354, 2017 Mar-Apr. |
Observational-Tx |
52 patients |
We compare the long-term outcomes of the transjugular intrahepatic portosystemic shunt (TIPS) and the balloon-occluded retrograde transvenous obliteration (BRTO) procedures based on our institutional experience. |
There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months. |
2 |
| 17. Lo GH, Liang HL, Chen WC, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007;39(8):679-685. |
Observational-Tx |
72 patients |
To compare the efficacy and complications of endoscopic obturation and transjugular intrahepatic portosystemic shunts (TIPSs). |
Stent shunt insertion was successful in all TIPS patients, and mean portal pressure gradient decreased from 21.4 +/- 7.5 mm Hg to 7.5 +/- 3.5 mm Hg ( P < 0.001). Variceal obliteration was achieved in 19 patients in the cyanoacrylate group (51 %) compared with seven TIPS patients (20 %) ( P < 0.02). After a median follow up of 33 months, upper gastrointestinal bleeding occurred in 15 TIPS patients (43 %) and 22 cyanoacrylate patients (59 %) ( P = 0.12). Rebleeding from gastric varices was encountered in four TIPS patients (11 %) and 14 cyanoacrylate patients (38 %) ( P = 0.014; odds ratio 3.6, 95 %CI 1.2 - 11.1). Blood transfusion requirements were lower in the TIPS group than in the cyanoacrylate group ( P < 0.01). Survival and frequency of complications were similar in both groups. |
1 |
| 18. Ninoi T, Nakamura K, Kaminou T, et al. TIPS versus transcatheter sclerotherapy for gastric varices. AJR Am J Roentgenol. 2004;183(2):369-376. |
Observational-Tx |
104 patients |
To compare the efficacy and long-term results of TIPS with those of transcatheter sclerotherapy for the treatment of gastric varices. |
The cumulative gastric variceal bleeding rate at 1 year was 20% in the TIPS group and 2% in the transcatheter sclerotherapy group (P<0.01). The prognostic factor associated with gastric variceal bleeding was the treatment method. The cumulative survival rates at 1, 3, and 5 years were, respectively, 81%, 64%, and 40% in the TIPS group and 96%, 83%, and 76% in the transcatheter sclerotherapy group (P<0.01). The prognostic factors for survival were the treatment method and the Child-Pugh classification of liver disease. For patients categorized in Child-Pugh class A, the survival rate was higher in the transcatheter sclerotherapy group than in the TIPS group (P<0.01). For patients in Child-Pugh classes B and C, no significant difference was seen between the 2 groups. Liver function tended to improve in the transcatheter sclerotherapy group |
2 |
| 19. Rees CJ, Nylander DL, Thompson NP, Rose JD, Record CO, Hudson M. Do gastric and oesophageal varices bleed at different portal pressures and is TIPS an effective treatment? Liver. 2000;20(3):253-256. |
Review/Other-Tx |
64 patients |
To assess the difference in PSPG measured at the time of TIPS insertion between patients bleeding from gastric and those bleeding from oesophageal varices. Rebleeding and mortality rates between the two groups were also compared. |
There was no significant difference in median PSPG between patients with GVH, 21 mmHg (range 15-30 mmHg) and OVH, 22 mmHg (range 12-45 mmHg). Following TIPS, PSPG was 8.5 mmHg (range 3-11 mmHg) and 9 mmHg (range 4-20 mmHg) in GVH and OVH patients respectively. Rebleeding occurred in 2/12 (16%) GVH patients and 12/52 (23%) OVH patients (p= 1.0). Mortality during follow up was 25% (4/12) in the GVH and 25% (13/52) in the OVH patients. |
4 |
| 20. Sabri SS, Abi-Jaoudeh N, Swee W, et al. Short-term rebleeding rates for isolated gastric varices managed by transjugular intrahepatic portosystemic shunt versus balloon-occluded retrograde transvenous obliteration. J Vasc Interv Radiol. 2014;25(3):355-361. |
Observational-Tx |
50 patients |
To assess the short-term rebleeding rate associated with the use of a transjugular intrahepatic portosystemic shunt (TIPS) compared with balloon-occluded retrograde transvenous obliteration (BRTO) for management of gastric varices (GV). |
The technical success rate was 100% in the TIPS group and 91% in the BRTO group (P = .21). Major complications occurred in 4% of the patients receiving TIPS and 9% of patients the undergoing BRTO (P = .344). Encephalopathy was reported in 4 of 27 (15%) patients in the TIPS group and in none of the patients in the BRTO group (0%; P = .12). At 12 months, the incidence of rebleeding from a GV source was 11% in the TIPS group and 0% in the BRTO group (P = .25). |
2 |
| 21. Lakhoo J, Bui JT, Lokken RP, Ray CE Jr, Gaba RC. Transjugular Intrahepatic Portosystemic Shunt Creation and Variceal Coil or Plug Embolization Ineffectively Attain Gastric Variceal Decompression or Occlusion: Results of a 26-Patient Retrospective Study. J Vasc Interv Radiol. 27(7):1001-11, 2016 07. |
Observational-Tx |
26 patients |
To assess the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation with or without variceal coil and/or plug embolization in decompressing or occluding gastric varices (GVs). |
GVs included gastroesophageal varix types 1 (n = 10) and 2 (n = 2), isolated GV types 1 (n = 4) and 2 (n = 2), and unspecified (n = 8). TIPS creation resulted in a median final portosystemic pressure gradient of 7 mm Hg. Multiple GV-supplying vessels (left/posterior/short gastric veins) were present in 65% of patients (n = 17). Embolization was performed in 69% (n = 18). Thirteen, four, and nine patients had imaging, endoscopic, or both imaging/endoscopic follow-up. GV patency rate was 65% (n = 17; 61%/75% with/without embolization) at a median of 128.5 days (range, 1-1,295 d) after TIPS creation. Incidence of recurrent bleeding was 27% (n = 7), and the 90-day mortality rate was 15% (n = 4). |
2 |
| 22. Jiang Q, Wang MQ, Zhang GB, Wu Q, Xu JM, Kong DR. Transjugular intrahepatic portosystemic shunt combined with esophagogastric variceal embolization in the treatment of a large gastrorenal shunt. World J Hepatol. 2016;8(20):850-857. |
Observational-Tx |
81 patients |
To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with stomach and esophageal variceal embolization (SEVE) in cirrhotic patients with a large gastrorenal vessel shunt (GRVS). |
The PPGs before TIPS were greater than 12 mmHg in 81 patients. TIPS + SEVE treatment caused a significant decrease in PPG (from 37.97 +/- 6.36 mmHg to 28.15 +/- 6.52 mmHg, t = 19.22, P < 0.001). The percentage of reduction in PPG was greater than 20% from baseline. There were no significant differences in albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time, or Child-Pugh score before and after operation. In all patients, rebleeding rates were 3%, 6%, 12%, 18%, and 18% at 1, 3, 6, 12, and 18 mo, respectively. Five patients (6.2%) were diagnosed as having hepatic encephalopathy. The rates of shunt dysfunction were 0%, 4%, 9%, 26%, and 26%, at 1, 3, 6, 12, and 18 mo, respectively. The cumulative survival rates in 1, 3, 6, 12, and 18 mo were 100%, 100%, 95%, 90%, and 90%, respectively. |
1 |
| 23. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Transjugular retrograde obliteration for chronic portosystemic encephalopathy. Abdom Imaging. 2000;25(6):567-571. |
Review/Other-Tx |
20 patients |
To evaluate the transjugular retrograde obliteration (TJO) in treatment of gastric varices with gastrorenal shunt. |
In all cases, gastric varices were obliterated successfully. Endoscopic examination 3 months after treatment revealed the complete eradication of gastric varices in all cases. No major complications during or after therapy were observed. |
4 |
| 24. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery. 2001;129(4):414-420. |
Review/Other-Tx |
52 patients |
To examine our experience with transjugular retrograde obliteration (TJO) during an 8-year period and to determine the long-term effects of this treatment. |
The gastric varices were successfully obliterated by TJO in all cases. The complications were all minor and transient. The mortality rate for TJO was 0%. There was no recurrence and no bleeding of gastric varices at all after TJO. Patient survival differed depending on the presence or absence of HCC (P <.05). The development of HCC in the cirrhotic liver was the most common cause of late death. Gastrointestinal bleeding was not a cause of death. The occurrence rate of esophageal varices after TJO was high, but these varices could be treated easily by endoscopic injection sclerotherapy before they bled. |
4 |
| 25. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices. Hepatogastroenterology. 2004;51(59):1379-1381. |
Review/Other-Tx |
1 patient |
To describe the control of a case of chronic portosystemic encephalopathy with esophageal varices using a combination treatment of transjugular retrograde obliteration and endoscopic embolization. |
After transjugular retrograde obliteration, the encephalopathy improved to grade 0 even without the administration of lactulose and branched-chain amino acid. The plasma ammonia level and ICGR15 were reduced to 62 microg/dL and 26%. |
4 |
| 26. Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol. 2001;12(3):327-336. |
Observational-Tx |
43 patients. |
To evaluate the long-term results of balloon-occluded retrograde transvenous obliteration (B-RTO) for the treatment of gastric varices and hepatic encephalopathy. |
Gastric varices disappeared or decreased markedly in size, and hepatic encephalopathy was completely cured in all patients. Improvement in Child-Pugh score was observed in 21 patients (50%) 6 months after B-RTO, but in only 11 patients (25.6%) 1 year after B-RTO. Cumulative relapse-free survival rate was 90.8% at 1 year and 87.4% at 3 years after B-RTO. B-RTO is a safe and effective treatment for patients with gastric varices and hepatic encephalopathy. The most significant prognostic factor was Child-Pugh classification (relative risk: 4.16) |
2 |
| 27. Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211(2):349-356. |
Review/Other-Tx |
20 patients |
To evaluate the clinical efficacy, techniques, and complications associated with balloon-occluded retrograde transvenous obliteration of gastric varices. |
Technical success was achieved in all patients. Occlusion of collateral veins was essential for the occlusion of gastric varices with a grade greater than grade 2. The clinical symptoms of hepatic encephalopathy in the three patients improved remarkably. Follow-up endoscopy 3 months after the procedure revealed the disappearance of gastric varices in 15 patients and reduced variceal size in five. During the follow-up period, 19 patients had no recurrence of gastric varices; three patients had aggravation of the esophageal varices. |
4 |
| 28. Park KS, Kim YH, Choi JS, et al. [Therapeutic efficacy of balloon-occluded retrograde transvenous obliteration in patients with gastric variceal bleeding]. Korean J Gastroenterol. 2006;47(5):370-378. |
Review/Other-Tx |
28 patients |
To analyze the results of our experience with balloon-occluded retrograde transvenous obliteration (BRTO) over a 39 month period. |
Twenty three men and five women were involved, and the mean age was 53.7+/-9.6 years. Technical and clinical success rates were 89.3% and 85.7%, respectively. Follow-up duration was 17.5+/-12.5 months in 23 patients. Gastric varices disappeared in 78.3% and decreased in 21.7%. Relapses occurred in 4.3% of the patients. Preexisting hepatic encephalopathy improved in all 11 patients. Aggravation of ascites, esophageal varices, portal hypertensive gastropathy were observed in 45.8%, 30.4%, 56.5%, respectively. Increased Child-Pugh score (p < 0.001) and decreased albumin concentration (p = 0.002) were observed 3 days after BRTO, but resolved 7 days later. Increased albumin concentration and decreased Child-Pugh score maintained thereafter. Rebleeding occurred in 3 patients which were caused by esophageal varices. Two-year survival rate was 54.6%. Presence of hepatocellular carcinoma (HCC) (p = 0.001) and Child-Pugh grade (p = 0.033) affected the survival, but HCC was the only independent risk factor (p = 0.010, OR = 15.837) in multivariate analysis |
4 |
| 29. Takuma Y, Nouso K, Makino Y, Saito S, Shiratori Y. Prophylactic balloon-occluded retrograde transvenous obliteration for gastric varices in compensated cirrhosis. Clin Gastroenterol Hepatol. 2005;3(12):1245-1252. |
Experimental-Tx |
34 patients |
To investigate the effectiveness of balloon-occluded retrograde transvenous obliteration (B-RTO) for the treatment of gastric fundal varices. |
The respective nonbleeding rates at 1, 3, and 5 years were 100%, 100%, and 83% in the B-RTO group and 81%, 59%, and 39% in the control. The respective cumulative survival rates at 1, 3, and 5 years were 94%, 85%, and 39% in the B-RTO group and 71%, 41%, and 22% in the control. Both the nonbleeding rate and the cumulative survival rate of the B-RTO group were significantly higher than those of the control (P = .01 and .04, respectively). B-RTO was determined by multivariate analysis to be a significant factor for low bleeding rate (relative risk, 0.06; 95% confidence interval [CI], 0.004-0.79), whereas B-RTO (0.11; 95% CI, 0.03-0.44) and Child-Pugh class A (0.10; 95% CI, 0.03-0.39) were the significant factors for a low mortality rate, and the presence of hepatocellular carcinoma (5.68; 95% CI, 1.49-21.7) was the significant factor for a high mortality rate. |
1 |
| 30. Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Infusion of 50% glucose solution before injection of ethanolamine oleate during balloon-occluded retrograde transvenous obliteration. Australas Radiol. 2007;51(4):334-338. |
Review/Other-Tx |
5 patients |
To assess the feasibility of infusion of 50% glucose solution before balloon-occluded retrograde transvenous obliteration (BRTO) to occlude collateral vessels draining gastric varices other than gastrorenal shunt was evaluated. |
The degree of collateral vessels had decreased when BRTO was carried out so that sclerotic agents sufficiently occupied the gastric varices in all patients. In three patients, embolization of collateral vessels with coils was unnecessary. There were no complications. |
4 |
| 31. Chikamori F, Shibuya S, Takase Y, Ozaki A, Fukao K. Transjugular retrograde obliteration for gastric varices. Abdom Imaging. 1996;21(4):299-303. |
Review/Other-Tx |
20 patients.
|
To evaluate the transjugular retrograde obliteration (TJO) in treatment of gastric varices with gastrorenal shunt. |
Endoscopic examination 3 months after treatment revealed the complete eradication of gastric varices in all cases. No major complications during or after therapy were observed. |
4 |
| 32. Arai H, Abe T, Shimoda R, Takagi H, Yamada T, Mori M. Emergency balloon-occluded retrograde transvenous obliteration for gastric varices. J Gastroenterol. 2005;40(10):964-971. |
Review/Other-Tx |
11 patients |
To evaluate the efficacy of emergency balloon-occluded retrograde transvenous obliteration (B-RTO) performed within 24 h after initial hemostasis for the prevention of rebleeding from ruptured gastric varices |
The 4 patients with acute bleeding from ruptured gastric varices were treated with endoscopic therapy-endoscopic variceal ligation (EVL) in 2 patients, and clipping treatment in 2. Initial hemostasis was achieved in all 4; the other 7 patients had already stopped bleeding at endoscopy. After hemostasis was achieved, emergency B-RTO was immediately performed within 24 h and was successful in all 11 patients. Ten (90.9%) of the 11 gastric varices were obliterated and the other 1 (9.1%) was diminished in size. During the mean follow-up period of 1136 days, no rebleeding or recurrence as found. Four patients died during the follow-up period, but none died from variceal bleeding. Survival rates were 90.9% and 70.7%, respectively, at 1 year and 3 years. In 6 patients, development of esophageal varices appeared during the follow-up period, all of which were controlled by usual endoscopic therapy. No severe side effects were found after the B-RTO treatment. |
4 |
| 33. Ferral H, Patel NH. Selection criteria for patients undergoing transjugular intrahepatic portosystemic shunt procedures: current status. J Vasc Interv Radiol. 2005;16(4):449-455. |
Review/Other-Tx |
N/A |
To review the most important scoring systems that have been developed and applied to patients undergoing emergency or elective TIPS procedures, with particular emphasis on the prognostic index designed for patients undergoing emergency TIPS procedures and the Model for End-stage Liver Disease score designed for patients undergoing elective TIPS procedures. |
No results stated in abstract |
4 |
| 34. Saad WE, Sabri SS. Balloon-occluded Retrograde Transvenous Obliteration (BRTO): Technical Results and Outcomes. Semin Intervent Radiol. 2011;28(3):333-338. |
Review/Other-Tx |
N/A |
To discuss balloon-occluded retrograde transvenous obliteration (BRTO) as an established procedure for the management of gastric varices in Japan that has shown promising results in the past decade. |
The advantage of diverting blood into the portal circulation and potentially toward the liver is improved hepatic function and possible patient survival. Unfortunately, the improved hepatic function is transient (for 6-12 months); however, it is preserved in the long-term (1-3 years). Patient 1-, 2-, 3-, and 5-year survival rates are 83-98%, 76-79%, 66-85%, and 39-69%, respectively. Patient survival is determined by baseline hepatic reserve and the presence of hepatocellular carcinoma. |
4 |
| 35. Cho SK, Shin SW, Lee IH, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol. 2007;189(6):W365-372. |
Review/Other-Tx |
49 patients |
To evaluate the clinical outcomes, techniques, and complications of balloon-occluded retrograde transvenous obliteration for treating gastric varices with spontaneous gastrosystemic shunts. |
There were six procedural failures and two procedure-related deaths. Disappearance or marked shrinkage of the treated gastric varices with no recurrent gastric variceal bleeding was noted in 39 patients (79.6% clinical success rate). Approximately two thirds of our patients experienced worsening of esophageal varices during the median follow-up period of 457 days. The cumulative survival rates at 1 year and 3 years after balloon-occluded retrograde transvenous obliteration were 83.1% and 65.7%, respectively. The prognostic factors associated with survival were the preprocedural Child-Pugh classification and the total bilirubin level. The survival rates and procedural outcomes for the patients with severely compromised liver function were poor. |
4 |
| 36. Kumamoto M, Toyonaga A, Inoue H, et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol. 2010;25(6):1129-1135. |
Observational-Tx |
59 patients |
After a 3-year follow-up period the Child-Pugh scores showed significant differences among the SRS (+), SRS (-), and B-RTO groups. The score worsened for the SRS (+) group. The cumulative survival rates were significantly different between the SRS (+) and SRS (-) groups and between the SRS (+) and B-RTO groups. The vital prognosis worsened for the SRS (+) group. |
After a 3-year follow-up period the Child-Pugh scores showed significant differences among the SRS (+), SRS (-), and B-RTO groups. The score worsened for the SRS (+) group. The cumulative survival rates were significantly different between the SRS (+) and SRS (-) groups and between the SRS (+) and B-RTO groups. The vital prognosis worsened for the SRS (+) group. |
2 |
| 37. Matsumoto A, Hamamoto N, Nomura T, et al. Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices. Am J Gastroenterol. 1999;94(3):643-649. |
Review/Other-Tx |
10 patients |
To investigate the relationship between portal hemodynamics and the occurrence of esophageal varices after prophylactic balloon-occluded retrograde transvenous obliteration. |
Fundal varices disappeared endoscopically in all 10 patients and the gastrorenal shunt was also occluded after the procedure. No patient showed worsening of liver function or systemic complications during follow-up. The increase in portal blood flow was more significant in type Ib patients than in the others. Esophageal varices occurred in all type I patients, and as to those in type Ib, high risk varices developed within 6 months after treatment. On the other hand, esophageal varices did not occur in type II patients. |
4 |
| 38. Miyamoto Y, Oho K, Kumamoto M, Toyonaga A, Sata M. Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension. J Gastroenterol Hepatol. 2003;18(8):934-942. |
Review/Other-Tx |
14 patients |
To discuss our experience with balloon-occluded retrograde transvenous obliteration (B-RTO) for the treatment of large gastric fundal varices with spontaneous splenorenal shunt (SRS). |
The B-RTO was successful in all patients. Contrast-enhanced computed tomography showed complete obliteration of the SRS prior to the follow-up measurements. Endoscopic eradication of the fundal varices was obtained 6 months after B-RTO in all patients and encephalopathy was improved within 1 week after B-RTO. Following the B-RTO, hepatic blood flow (441 +/- 214 vs 668 +/- 299 mL/min, P < 0.0001) and the intrinsic clearance of ICG (233 +/- 123 vs 285 +/- 148 mL/min, P < 0.05) were significantly increased. Furthermore, intrahepatic resistance decreased after the B-RTO (P < 0.005). |
4 |
| 39. Yamamoto A, Nishida N, Morikawa H, et al. 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):1160-7, 2016 Aug. |
Observational-Tx |
50 patients |
To investigate predictive factors and cutoff value of transient elastography (TE) measurements for assessing improvement in liver function after balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices (GV). |
Serum albumin was significantly improved at 3 months after BRTO (3.57 g/dL vs 3.74 g/dL, P < .001). There was a significant negative correlation between change in albumin and baseline LSM (r = -0.50, P < .001). The best cutoff point for LSM was </= 22.9 kPa, with sensitivity and specificity of 78.4% and 69.2%, respectively, for predicting which patients would have improved albumin after BRTO. Among 33 patients, 29 (88%) patients had improved albumin. The 1-year progression rate of EV after BRTO was 13.6% in patients with LSM </= 22.9 kPa. |
2 |
| 40. Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices: Part 2. Strategy and techniques based on hemodynamic features. Radiographics. 2003;23(4):921-937; discussion 937. |
Review/Other-Tx |
N/A |
To discuss balloon-occluded retrograde transvenous obliteration (BRTO) as the treatment of choice for gastric varices at many institutions in Japan. |
Additional techniques are required for successful treatment. These techniques include stepwise injection of the sclerosing agent, selective injection of the agent via a microcatheter, coil embolization of the afferent gastric veins, double-balloon catheterization, and BRTO performed with percutaneous transhepatic portal venous access or transileocolic venous access. The majority of gastric varices can be treated successfully with a combination of these techniques. However, accurate assessment of the variceal hemodynamic pattern is the most important factor in ensuring successful treatment. |
4 |
| 41. Chang IS, Park SW, Kwon SY, et al. Efficacy and Safety of Balloon-Occluded Retrograde Transvenous Obliteration with Sodium Tetradecyl Sulfate Liquid Sclerotherapy. Korean J Radiol. 2016;17(2):224-229. |
Observational-Tx |
17 patients |
To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices. |
Technical success was achieved in 16 of 17 patients (94.1%). The procedure failed in one patient because the shunt could not be occluded due to the large diameter of gastrorenal shunt. Complete obliteration of gastric varices was observed in 15 of 16 patients (93.8%) with follow-up CT or endoscopy. There was no rebleeding after the procedure. There was no procedure-related mortality. |
2 |
| 42. Choi SY, Won JY, Kim KA, Lee DY, Lee KH. Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO). Eur Radiol. 2011;21(1):122-129. |
Review/Other-Tx |
16 patients |
To evaluate the clinical safety and effectiveness of foam sclerotherapy using polidocanol for the treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration (BRTO). |
Technical success was achieved in 15 of 16 patients (93.8%). Technical failure occurred in one patient. All patients were without pain during sclerotherapy. One patient experienced pulmonary edema after the procedure but completely recovered with medical treatment. There was no procedure-related mortality. Patients were followed by endoscopy, computed tomography, or both. Four patients were lost to follow-up. Clinical success was achieved in 10 of 11 patients (91%). Rebleeding occurred in one case during follow-up. |
4 |
| 43. Gwon DI, Kim YH, Ko GY, et al. Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices and Hepatic Encephalopathy: A Prospective Multicenter Study. J Vasc Interv Radiol. 26(11):1589-95, 2015 Nov. |
Review/Other-Tx |
57 patients |
To evaluate technical and clinical outcomes of vascular plug-assisted retrograde transvenous obliteration (PARTO) for the treatment of gastric varices (GVs) and hepatic encephalopathy (HE). |
Placement of the vascular plug and subsequent gelatin sponge embolization were technically successful in all 73 patients. There were no procedure-related complications. Follow-up CT obtained within 1 wk after PARTO showed complete thrombosis of GVs and portosystemic shunts in 72 of 73 patients (98.6%). Sixty patients who underwent follow-up longer than 3 mo showed complete obliteration of GVs and portosystemic shunts. There were no cases of variceal bleeding or HE at the end of follow-up (mean, 544 d). Improvement in Child-Pugh score was observed in 24 patients (40%) at 1-mo follow-up. Worsening of ascites and esophageal varices was observed in 14 (23.3%) and 16 (26.7%) patients at 3-mo follow-up. |
4 |
| 44. Gwon DI, Ko GY, Yoon HK, et al. Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report. Radiology. 268(1):281-7, 2013 Jul. |
Observational-Tx |
20 patients |
To evaluate technical safety, clinical safety, and effectiveness of vascular plug-assisted retrograde transvenous obliteration (RTO) for treatment of gastric varices (GV) and hepatic encephalopathy (HE). |
Placement of the vascular plug and subsequent gelatin-sponge embolization were technically successful in all 20 patients, with no procedure-related complications. Follow-up CT within 1 week after vascular plug-assisted RTO showed complete thrombosis of GV and gastrorenal shunts in all patients. Clinical symptoms of HE completely resolved in all seven patients with HE; mean serum NH3 level of 127.4 mumol/L +/- 58 (standard deviation) before vascular plug-assisted RTO decreased significantly to 28.1 mumol/L +/- 9.8 within 1 week after vascular plug-assisted RTO (P = .002). Eighteen patients who underwent follow-up longer than 2 months showed complete obliteration of GV and gastrorenal shunts at CT and endoscopy. There were no cases of variceal bleeding or HE during mean follow-up of 422 days. Improvement in Child-Pugh score was observed in 12 of 18 (67%) patients 1 month after vascular plug-assisted RTO. Worsening of esophageal varices was observed in four (22%) patients at mean follow-up of 9.4 months. |
2 |
| 45. Itou C, Koizumi J, Hashimoto T, et al. Balloon-Occluded Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: Polidocanol Foam Versus Liquid Ethanolamine Oleate. AJR Am J Roentgenol. 2015;205(3):659-666. |
Observational-Tx |
41 patients |
To evaluate the clinical results of the management of gastric varices by balloon-occluded retrograde transvenous obliteration with polidocanol foam versus ethanolamine oleate. |
Complete obliteration was confirmed in all but one case of early recanalization after treatment with polidocanol foam. One patient died of acute respiratory distress syndrome after treatment with ethanolamine oleate. The total sclerosant volume was significantly lower for 3% polidocanol foam (13.5 +/- 6.8 mL) than for 5% ethanolamine oleate (30.6 +/- 15.6 mL) (p < 0.01). Polidocanol foam caused fewer severe reactions, including pain, during and after injection. High body temperature, hemoglobinuria, and reactive pleural effusion were not observed with polidocanol foam. The variance in laboratory data values associated with hemolysis was significantly greater with ethanolamine oleate. No postprocedural rebleeding from the gastric varices was observed during a median follow-up time of 39.5 months after procedures with ethanolamine oleate and 34 months after procedures with polidocanol foam. |
2 |
| 46. Jang SY, Kim GH, Park SY, et al. Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis: a retrospective multicenter study. Clin Mol Hepatol. 2012;18(4):368-374. |
Review/Other-Tx |
183 patients |
To evaluate the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC). |
Of the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0+/-29.2 months (mean+/-SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047). |
4 |
| 47. Kitamoto M, Imamura M, Kamada K, et al. Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. AJR Am J Roentgenol. 2002;178(5):1167-1174. |
Observational-Tx |
24 consecutive patients |
To evaluate the clinical efficacy, feasibility, and complications of balloon-occluded retrograde transvenous obliteration (B-RTO) for patients with hemorrhage from gastric fundal varices. |
Cannulation into the outflow vessels was performed in 23 patients, but the balloon catheter could not be inserted in one patient who had inferior phrenic vein outflow. Complete success was obtained in 88% (21/24) of patients, and partial success was obtained in two patients. In nine of 11 patients with acute bleeding, complete success was achieved. Rebleeding from gastric varices was not observed in patients treated with complete success, whereas two patients treated partially rebled within 1 week of the treatment (rate of rebleeding, 9%). Eradication of gastric varices was obtained in all patients (n = 19) who were examined by endoscopy 3 months after the treatment. Eight patients experienced worsening of esophageal varices. These patients were treated endoscopically because of findings that suggested a risk of hemorrhage. The overall mortality rate was 4% (1/24). No damage to the kidney was observed, although 11 patients had macrohematuria. |
2 |
| 48. Kobayakawa M, Kokubu S, Hirota S, et al. Short-Term Safety and Efficacy of Balloon-Occluded Retrograde Transvenous Obliteration Using Ethanolamine Oleate: Results of a Prospective, Multicenter, Single-Arm Trial. J Vasc Interv Radiol. 2017;28(8):1108-1115 e1102. |
Review/Other-Tx |
45 patients |
To evaluate 90-day outcomes after balloon-occluded retrograde transvenous obliteration (BRTO) with ethanolamine oleate (EO) in patients with gastric varices (GVs). |
Forty-five patients (26 men and 19 women; mean age, 67.8 y) were enrolled. The complete regression rate of GVs based on endoscopic images on day 90 was 79.5% (35 of 44 patients; 95% confidence interval, 64.7%-90.2%). The rate of complete thrombosis of GVs based on contrast-enhanced CT on day 90 was 93.0% (40 of 43 patients; 95% confidence interval, 80.9%-98.5%). One patient experienced 2 events of bleeding from GVs, which was different from the GVs treated with BRTO. Appearance of new esophageal varices (EVs) or worsening of existing EVs occurred in 16 of 45 patients (35.6%). Forty-four of 45 patients (97.8%) experienced adverse events (AEs) related to EO, which included fever in 24 (53.3%), hematuria in 23 (51.1%), hemolysis in 16 (35.6%), back pain in 16 (35.6%), and abdominal pain in 10 (22.2%). One case of moderate to severe ascites (2.3%) was observed on day 90. One case of sepsis was the only serious AE observed in relation to EO. |
4 |
| 49. Koizumi J, Hashimoto T, Myojin K, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: use of CT-guided foam sclerotherapy to optimize technique. AJR Am J Roentgenol. 2012;199(1):200-207. |
Observational-Tx |
27 patients |
To evaluate the performance of foam sclerotherapy with C-arm CT guidance to reduce the amount of sclerosant and to optimize the safety of balloon-occluded retrograde transvenous obliteration while preserving its efficacy. |
In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration (3.9 +/- 1.5 mL) was significantly smaller (p < 0.001) than the dose of contrast medium used for venography (16.4 +/- 7.9 mL). Hemoglobinuria was found in only one patient. Except in one instance of recanalization, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration (success rate, 95%). In one patient, air migrated into the liver during transvenous obliteration but was spontaneously absorbed. No serious complication occurred. |
2 |
| 50. Mukund A, Deogaonkar G, Rajesh S, Shasthry SM, Sarin SK. Safety and Efficacy of Sodium Tetradecyl Sulfate and Lipiodol Foam in Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Large Porto-Systemic Shunts. Cardiovasc Intervent Radiol. 2017;40(7):1010-1016. |
Review/Other-Tx |
22 patients |
To evaluate the safety and efficacy sodium tetradecyl sulfate and lipiodol foam (STS foam) in BRTO for large (caliber >/=15 mm) porto-systemic shunt and gastric fundal varices. |
Records of 22 patients were analyzed. Technical success was achieved in 22 of 22 sessions. Complete obliteration of shunt with clinical improvement was seen in 20 of 22 cases. Patients with gastric varices had no residual gastric varices on follow-up endoscopy. There were significant reduction in CTP scores and improvement in HE grades following BRTO. Post-procedure complication was encountered in 6 patients (5 minor and 1 major), and 7 patients showed worsening of esophageal varices and underwent endoscopic variceal ligation. One patient had succumbed to septicemia at a follow-up of 34 months. |
4 |
| 51. Ninoi T, Nishida N, Kaminou T, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR Am J Roentgenol. 2005;184(4):1340-1346. |
Observational-Tx |
78 patients |
Retrospective cohort study to evaluate the long-term clinical results after balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices with spontaneous gastrorenal shunt. |
Recurrence of gastric varices was found in two patients; the 5-year recurrence rate was 2.7%. Bleeding of gastric varices occurred in only one patient after B-RTO; the 5-year bleeding rate was 1.5%. Worsening of esophageal varices was observed in 29 patients, and the worsening rates at 1, 3, and 5 years were 27%, 58%, and 66%, respectively. These esophageal varices were endoscopically treated to prevent rupture. Multivariate analysis showed the presence of esophageal varices before B-RTO was a prognostic factor for worsening (relative risk, 4.956). At a median follow-up of 700 days (range, 137-2,339 days), the survival rates at 1, 3, and 5 years were 93%, 76%, and 54%, respectively. The prognostic factors associated with survival were presence of hepatocellular carcinoma (relative risk, 24.342) and the Child-Pugh classification (relative risk, 5.780). |
2 |
| 52. Sabri SS, Swee W, Turba UC, et al. Bleeding gastric varices obliteration with balloon-occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam. J Vasc Interv Radiol. 2011;22(3):309-316; quiz 316. |
Review/Other-Dx |
22 patients |
To describe their initial experience with BRTO using sodium tetradecyl sulfate (STS) foam as an alternative sclerosing agent. |
The authors performed BRTO in 22 cirrhotic patients (11 men and 11 women) with a mean age of 52 years (range, 23-83 years). Technical success was achieved in 20 of 22 (91%) patients. Complications occurred in three of 22 (14%) patients. The overall mean dose of STS used was 300 mg (range, 30-600 mg) with mean total volume of sclerosant mixture of 34.1 mL (range, 10-65 mL). Follow-up imaging was available for 18 of 20 (90%) technically successful procedures with a mean period of 89 days (range, 1-359 days). Complete obliteration of GV was achieved in 16 of 18 (89%) patients. There were no cases of recurrent variceal bleeding with a mean clinical follow-up period of 130 days (range, 1-510). |
4 |
| 53. Akahoshi T, Hashizume M, Tomikawa M, et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience. J Gastroenterol Hepatol. 2008;23(11):1702-1709. |
Review/Other-Tx |
68 patients |
To investigate the long-term effects of B-RTO on rebleeding, prevention of first bleeding, mortality and occurrence of risky esophageal varices (EVx). |
B-RTO was successfully performed in 63 of 68 patients (92.6%). Varices eradication was confirmed by endoscopy in 61 of 63 patients (96.6%). During follow up, GVx bleeding occurred in two patients (3.2%). The 8-year cumulative rebleeding rates of patients with bleeding and risky GVx were 14% and 0%, respectively. Risky EVx occurred in 10 patients (17%) and the cumulative occurrence rate was 22% in 8 years. The cumulative occurrence rate of risky EVx was higher in GVx with EVx (GOV2-GVx) compared to GVx without EVx (IGV1, P < 0.05). No ectopic variceal bleeding occurred. No patients died from variceal bleeding. Hepatocellular carcinoma was the only significant prognostic factor (P < 0.05). |
4 |
| 54. Arai H, Abe T, Takagi H, Mori M. Efficacy of balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices. World J Gastroenterol. 2006;12(24):3866-3873. |
Observational-Tx |
93 patients |
To evaluate the effect of three interventional treatments involving transvenous obliteration for the treatment of gastric varices, and to compare the efficacy and adverse effects of these methods. |
The BRTO, PTO, and combined therapy were technically successful in 81% (75/93), 44% (8/18), and 100% (10/10) patients, respectively. Recurrence of gastric varices was found in 3 patients in the BRTO group and in 3 patients in the PTO group. Rebleeding was observed in 1 patient in the BRTO group and in 1 patient in the PTO group. The 1- and 3-year survival rates were 98% and 87% in the patients without hepatocellular carcinoma (HCC) in the BRTO group, 100% and 100% in the PTO group, and 90% and 75% in the combined therapy group, respectively. |
2 |
| 55. Chikamori F, Kuniyoshi N, Kawashima T, Takase Y. Gastric varices with gastrorenal shunt: combined therapy using transjugular retrograde obliteration and partial splenic embolization. AJR Am J Roentgenol. 2008;191(2):555-559. |
Review/Other-Tx |
14 patients |
To evaluate the effectiveness of the combination of transjugular retrograde obliteration and partial splenic embolization in the treatment of gastric varices with gastrorenal shunt. |
The disappearance rate of gastric varices after transjugular retrograde obliteration was 100% in both groups. The 3-year cumulative survival rate after transjugular retrograde obliteration was 92% in group 1 and 95% in group 2. The 3-year cumulative occurrence rate of esophageal varices after transjugular retrograde obliteration was 9% in group 1 and 45% in group 2, a significant difference (p < 0.05). |
4 |
| 56. Hong CH, Kim HJ, Park JH, et al. Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 2009;24(3):372-378. |
Experimental-Tx |
27 patients |
To evaluate the therapeutic results of endoscopic N-butyl-2-cyanoacrylate injection (EBC) and balloon-occluded retrograde transvenous obliteration (BRTO) in patients with gastric variceal hemorrhage (GVH) and/or high-risk gastric varices (GV). |
EBC or BRTO was initially used for the treatment of GVH in 14 and 13 patients, respectively. Technical success was achieved in all 14 patients (100%) initially treated with EBC, and 10 of 13 patients (76.9%) initially treated with BRTO. Significant rebleeding occurred in 10 patients (71.4%) of the EBC group, and two patients (15.4%) of BRTO group (P < 0.01). Five of six patients (83.3%) treated with rescue BRTO due to rebleeding after initial EBC achieved technical success, and all six patients who were treated with rescue BRTO had no rebleeding during the median follow up of 17 (range: 2-37) months. The cumulative survival rate of the EBC with the BRTO rescue group/BRTO group was significantly higher than the EBC group. |
1 |
| 57. Kiyosue H, Matsumoto S, Onishi R, et al. [Balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices: therapeutic results and problems]. Nihon Igaku Hoshasen Gakkai Zasshi. 1999;59(1):12-19. |
Review/Other-Tx |
19 patients |
To evaluate the usefulness of balloon-occluded retrograde transvenous obliteration (B-RTO) in the treatment of gastric varices. |
Nineteen patients (90%) were successfully treated with B-RTO. In 17 of them, CT within two weeks after B-RTO showed complete thrombosis of the gastric varices, and the varices had disappeared or markedly regressed on endoscopy after 1-3 months. In the other two patients, in whom CT showed partial thrombosis of the varices, the varices regressed minimally. Liver and renal function tests did not show significant changes in 17 of 19 patients (89%). Transient worsening of liver function was seen in one patient in whom a small amount of EOI moved into the splenic vein during balloon occlusion. Acute renal failure occurred in the other patient with the use of 50 ml of EOI. |
4 |
| 58. Koito K, Namieno T, Nagakawa T, Morita K. Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. AJR Am J Roentgenol. 1996;167(5):1317-1320. |
Review/Other-Tx |
30 patients |
To evaluate the efficacy of balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals |
After balloon-occluded retrograde transvenous obliteration, gastric varices disappeared completely in all 30 cases in 4-16 weeks (mean, 10 weeks). Recurrence of gastric varices was observed in three cases (10%), which were treated with repeated balloon-occluded retrograde transvenous obliteration. Esophageal varices were aggravated in three patients (10%), who underwent successful endoscopic injection sclerotherapy. Complications of balloon-occluded retrograde transvenous obliteration were fever and hemoglobinuria, which disappeared in about 5 days. We observed no significant hepatic and renal functional damage. |
4 |
| 59. Sonomura T, Sato M, Kishi K, et al. Balloon-occluded retrograde transvenous obliteration for gastric varices: a feasibility study. Cardiovasc Intervent Radiol. 1998;21(1):27-30. |
Review/Other-Tx |
14 patients |
To evaluate the clinical feasibility of balloon-occluded retrograde transvenous obliteration (BORTO) for gastric varices. |
BORTO was performed in 14 patients with gastric varices due to liver cirrhosis. The gastric varices were confirmed by endoscopy, and their feeding and draining veins were identified by contrast-enhanced computed tomography (CT) and angiography. A 6 Fr Simmons-shaped balloon catheter was inserted into the gastrorenal shunt. The balloon was inflated, and 5% ethanolamine oleate iopamidol was infused slowly through the catheter. Patients were followed up with endoscopy and enhanced CT at 1 week, 1, 3, and 6 months after the procedure and every 6 months thereafter. RESULTS: The gastric varices completely disappeared in 12 of 14 patients and was partially resolved in the remaining 2 patients. Neither a recurrence nor an aggravation of gastric varices were found. No major complications were experienced. |
4 |
| 60. Park JK, Saab S, Kee ST, et al. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis. Dig Dis Sci. 2015;60(6):1543-1553. |
Meta-analysis |
1,016 Patients; 24 studies |
To perform a systematic review and meta-analysis of the effectiveness and complications of BRTO for gastric varices. |
A total of 1,016 Patients from 24 studies met inclusion criteria. Technical success rate for BRTO was 96.4 % (95 % CI 93.7, 98.3 %; Q = 3,269.26, p < 0.01, I (2) = 99.39 %). Clinical success (defined as no recurrence or rebleed of gastric varices, or complete obliteration of varices on subsequent imaging) rate was 97.3 % (95 % CI 95.2, 98.8 %; Q = 3,105.91, p < 0.01, I (2) = 99.29 %). Major complication rate was 2.6 % (95 % CI 1.1, 4.6 %; Q = 3,348.98, p < 0.01, I (2) = 99.34 %). Esophageal variceal recurrence rate was 33.3 % (95 % CI 24.6, 42.6 %; Q = 7,291.75, p < 0.01, I (2) = 99.74 %). |
Good |
| 61. Okugawa H, Maruyama H, Kobayashi S, Yoshizumi H, Matsutani S, Yokosuka O. Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein. Br J Radiol 2009;82:930-5. |
Review/Other-Tx |
34 patients |
To elucidate the relationship between the therapeutic effect of balloon-occluded retrograde transvenous obliteration (B-RTO) and haemodynamic features in the short gastric vein (SGV) in patients with gastric fundal varices (GV). |
Embolisation of GV was achieved in 30/34 patients (88.2%): 27 by initial B-RTO and 3 by second B-RTO. Flow velocity and flow volume in the SGV before B-RTO were significantly lower in the 27 patients with a complete effect on initial B-RTO (7.19+/-2.44 cm s(-1), p = 0.0246; 189.52+/-167.66 ml min(-1), p = 0.002) than in the 7 patients with an incomplete effect (10.41+/-5.44 cm s(-1), 492.14+/-344.94 ml min(-1)). Neither endoscopy nor contrast-enhanced CT had recurrent findings of GV in the subject during the follow-up period (94-1440 days; mean, 487.2+/-480.5 days). |
4 |
| 62. Kim ES, Park SY, Kwon KT, et al. [The clinical usefulness of balloon occluded retrograde transvenous obliteration in gastric variceal bleeding]. Taehan Kan Hakhoe Chi. 2003;9(4):315-323. |
Review/Other-Tx |
12 patients |
To evaluate the therapeutic effects and complications on follow-up of BRTO as a new treatment option for gastric variceal bleeding. |
Technical success was achieved in 12 of 13 patients (92%) with gastric variceal bleeding. There were no significant side effects. In the one case of failure, the bleeding was controlled with TIPS. Eleven of the 12 patients who had technical success were shown to be clinically successful. The follow-up endoscopic exam showed some aggravation of pre-existing esophageal varices in four patients and a new development of esophageal varices in two patients. Endoscopic variceal ligation was done on one patient in whom esophageal variceal bleeding was present during the follow-up period. |
4 |
| 63. Park SJ, Chung JW, Kim HC, Jae HJ, Park JH. The prevalence, risk factors, and clinical outcome of balloon rupture in balloon-occluded retrograde transvenous obliteration of gastric varices. J Vasc Interv Radiol. 2010;21(4):503-507. |
Review/Other-Tx |
69 patients |
To evaluate the prevalence, risk factors, and clinical outcome after balloon rupture during balloon-occluded retrograde transvenous obliteration (BRTO). |
The prevalence of balloon rupture was 8.7% (six of 69 patients). No significant risk factor for balloon rupture was identified because of the small number of balloon rupture cases. Migration of the sclerosant occurred in three patients with early balloon rupture within 1 hour. One of these patients died of recurrent gastric variceal bleeding and another experienced dyspnea and died of fungal sepsis. Among the 63 patients without rupture, no migration of the sclerosant was noted, and one patient died of sepsis caused by liver abscess. Incidences of sclerosant migration and in-hospital mortality were significantly higher in patients with balloon rupture versus patients without balloon rupture (P = .018 and P < .001, respectively). |
4 |
| 64. Shimoda R, Horiuchi K, Hagiwara S, et al. Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging. 2005;30(3):306-313. |
Observational-Tx |
38 patients |
To estimate the type, incidence, and severity of complications of balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices. |
Endoscopic evaluation at 8 weeks showed resolution of gastric varices in 35 of 38 patients (92%) and smaller varices in the remaining three (8%). B-RTO caused transient hypertension in 35% of patients, hemoglobinuria in 49%, and fever in 33% during phases 1, 2, and 3, respectively. Pleural effusion, pulmonary infarction, ascites, gastric ulcers with unique appearance, localized mosaic-like change of gastric mucosa, and hemorrhagic portal hypertensive gastropathy were noted in phase 4. There were no fatalities. Lactate dehydrogenase, aspartate aminotransferase, and bilirubin increased on day 1. Each datum was retrieved within 7 days. |
2 |
| 65. Jogo A, Nishida N, Yamamoto A, et al. Factors associated with aggravation of esophageal varices after B-RTO for gastric varices. Cardiovasc Intervent Radiol. 2014;37(5):1243-1250. |
Observational-Tx |
67patients |
To retrospectively evaluate risk factors for aggravation of esophageal varices (EV) within 1 year after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices (GV) and to clarify suitable timing for upper endoscopy to detect EV aggravation after B-RTO. |
B-RTO was successfully performed in all patients. EV aggravation at 1 year after B-RTO was found in 38 patients (56.7 %). Multivariate logistic regression analysis showed that total bilirubin (T-bil) (P = 0.032) and hepatic venous pressure gradient (HVPG) (P = 0.011) were significant independent risk factors for EV aggravation after B-RTO. Cutoff values of T-bil and HVPG yielding maximal combined sensitivity and specificity for EV aggravation were 1.6 mg/dL and 13 mmHg, respectively. The patients with T-bil >/= 1.6 mg/dL or HVPG >/= 13 mmHg had a median aggravation time of 5.1 months. All five patients with ruptured EV belonged to this group. In contrast, patients with T-bil < 1.6 mg/dL and HVPG < 13 mmHg had a median aggravation time of 21 months. |
2 |
| 66. Saad WE, Wagner CC, Lippert A, et al. Protective value of TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration (BRTO). Am J Gastroenterol. 2013;108(10):1612-1619. |
Observational-Tx |
39 patients |
To evaluate the incidence of post-balloon-occluded retrograde transvenous obliteration (BRTO) ascites/hepatic hydrothorax and rebleeding rate (variceal and non-variceal) in the presence and absence of a transjugular intrahepatic portosystemic shunt (TIPS). |
Thirty-nine patients underwent BRTO (three technical failures of BRTO-only group). Of the 36 technically successful BRTO procedures, 27 patients (75%) underwent BRTO-only and 9 patients (25%) underwent BRTO in the presence of a TIPS. Pre-BRTO ascites/hydrothorax resolved in BRTO-only vs. BRTO+TIPS in 7% (N=2/27) and 56% (N=5/9), respectively (P=0.006). The ascites/hydrothorax free rate at 6, 12, and 24 months after BRTO for BRTO-only vs. BRTO+TIPS was 58%, 43%, 29%, and 100%, 100%, 100%, respectively (P=0.01). Recurrent hemorrhage for BRTO-only vs. BRTO+TIPS groups, and for the same time periods was 9%, 9%, 21% vs. 0%, 0%, 0%, respectively (P=0.03). The 1-year patient survival of both groups (80-88%) was similar (P>0.05). |
2 |
| 67. Chikamori F, Kuniyoshi N, Kawashima T, Takase Y. Short-term portal hemodynamic effects of partial splenic embolization for hypersplenism. Hepatogastroenterology. 2007;54(78):1847-1849. |
Observational-Tx |
37 patients |
To investigate the short-term effects of partial splenic embolization (PSE) for hypersplenism on portal hemodynamics and liver function. |
The wedged hepatic venous pressure before and after PSE were 39 +/- 10 and 33 +/- 8 cmH2O, respectively, showing significant change (p < 0.01). The flow volumes of the splenic vein before and after PSE were 477 +/- 200 and 319 +/-187 mL/min, respectively, also showing significant change (p < 0.05). However, the flow volumes of the portal vein before and after PSE were 713 +/- 284 and 684 +/- 152 mL/min, respectively, showing no significant change. The blood laboratory parameters showed no significant change after PSE. PSE damaged neither the portal blood flow volume nor the liver function, although it improved the local hyperdynamic state in the splenic area and thrombocytopenia. |
3 |
| 68. Buechter M, Kahraman A, Manka P, et al. Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation. PLoS One. 2017;12(5):e0177401. |
Review/Other-Tx |
9 patients |
To retrospectively analyze 9 patients with PH-induced UGIB who underwent partial SE between 2012 and 2016. |
Five patients (56%) suffered from cirrhotic PH, 4 patients (44%) from non-cirrhotic PH. UGIB occured in terms of refractory hemorrhage from gastric varices (3/9; 33%), hemorrhage from esophageal varices (3/9; 33%), and finally, hemorrhage from portal-hypertensive gastropathy (3/9; 33%). None of the patients treated with partial SE experienced re-bleeding episodes or required blood transfusions during a total follow-up time of 159 months, including both patients with cirrhotic- and non-cirrhotic PH. |
4 |
| 69. Duan X, Zhang K, Han X, et al. Comparison of percutaneous transhepatic variceal embolization (PTVE) followed by partial splenic embolization versus PTVE alone for the treatment of acute esophagogastric variceal massive hemorrhage. J Vasc Interv Radiol. 2014;25(12):1858-1865. |
Observational-Tx |
65 patients |
To compare the efficacy of percutaneous transhepatic variceal embolization (PTVE) followed by partial splenic embolization (PSE) with that of PTVE alone for the treatment of acute massive hemorrhage of esophagogastric varices in patients with cirrhosis unable to undergo alternative procedures. |
Cumulative recurrent bleeding rates at 6, 12, and 24 months after intervention in the PTVE/PSE group were 3.2%, 6.7%, and 13.3%, compared with 20.6%, 36.7%, and 53.6%, respectively, in the PTVE group; the difference at each time point was statistically significant (all P < .01). There were more cases of ascites and portal hypertensive gastropathy after PTVE than after PTVE/PSE (P < .05). Survival rates at 6, 12, and 24 months in the PTVE/PSE group were 100%, 96.8%, and 96.8%, compared with 94.1%, 88.2%, and 82.4%, respectively, in the PTVE group. There were significant differences in peripheral blood cell counts and hemoglobin levels between the PTVE/PSE and PTVE groups at all observed time points (all P < .01). |
2 |
| 70. Waguri N, Hayashi M, Yokoo T, et al. Simultaneous combined balloon-occluded retrograde transvenous obliteration and partial splenic embolization for portosystemic shunts. J Vasc Interv Radiol. 2012;23(5):650-657. |
Observational-Tx |
20 patients |
To evaluate the efficacy and safety of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE) for gastric varices and/or hepatic encephalopathy. |
No significant differences were observed in baseline characteristics among the three groups except for significantly lower platelet counts and larger spleen volumes in group 3. In all cases in groups 1 and 2, gastric varices disappeared and hepatic encephalopathy improved after treatment. Procedure times were not significantly different between groups 1 and 2 (P = .7435). In group 1, the volume of sclerosing agent required for B-RTO was significantly lower (P = .0355) and exacerbation of esophageal varices was significantly less frequent (P = .0146) than in group 2. Few serious complications occurred in patients who received combined therapy. |
3 |
| 71. Ohmoto K, Yoshioka N, Tomiyama Y, et al. Improved prognosis of cirrhosis patients with esophageal varices and thrombocytopenia treated by endoscopic variceal ligation plus partial splenic embolization. Dig Dis Sci. 2006;51(2):352-358. |
Experimental-Tx |
84 patients |
To assess the efficacy of the combination of endoscopic variceal ligation (EVL) and partial splenic embolization (PSE) compared with EVL alone in cirrhosis patients with thrombocytopenia. |
Comparison between combined treatment and variceal ligation alone by multivariate analysis showed a hazard ratio of 0.44 for the recurrence of varices (P = 0.02), 0.19 for progression to variceal bleeding (P = 0.01), and 0.31 for death (P = 0.04). |
1 |
| 72. Bernades P, Baetz A, Levy P, Belghiti J, Menu Y, Fekete F. Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients. Dig Dis Sci. 1992;37(3):340-346. |
Review/Other-Tx |
35 patients |
To perform a prospective search for splenoportal venous obstruction (SPVO) in a medical-surgical series of 266 patients with chronic pancreatitis who were followed up a mean time of 8.2 years. SPVO was systematically searched for using ultrasonography and then confirmed by angiography or computed tomography. |
Esophageal varices were found in two patients and gastric varices in four at the time of diagnosis and during follow-up. At the end of follow-up, 12 patients had undergone splenopancreatectomy (N = 11) or splenectomy (N = 1). Only one patient was operated on for massive esophageal variceal bleeding, and another patient died due to intractable colic variceal bleeding. In four of six patients operated on with portal vein obstruction, surgery was difficult due to venous collaterals. Ten patients were not operated on and 13 patients operated on were not treated for SPVO. The mean follow-up after diagnosis of SPVO for these final 23 patients was 28.9 months. None of these patients bled. |
4 |
| 73. Orloff MJ, Hye RJ, Wheeler HO, et al. Randomized trials of endoscopic therapy and transjugular intrahepatic portosystemic shunt versus portacaval shunt for emergency and elective treatment of bleeding gastric varices in cirrhosis. Surgery. 2015;157(6):1028-1045. |
Experimental-Tx |
518 patients |
To describe the results of a prospective, randomized, controlled trial (RCT) in unselected, consecutive patients with BGV comparing endoscopic therapy (ET) with portacaval shunt (PCS; n = 518), and later comparing emergency transjugular intrahepatic portosystemic shunt (TIPS) with emergency portacaval shunt (EPCS; n = 70). |
In the expanded RCT of TIPS versus EPCS, 40 and 41%, respectively, were in Child class C. Permanent control of BGV was achieved in 97-100% of patients treated by emergency or elective PCS, compared with 27-29% by ET. TIPS was even less effective, achieving long-term control of BGV in only 6%. Survival rates after PCS were greater at all time intervals and in all Child classes (P < .001). Repeated episodes of PSE occurred in 50% of TIPS patients, 16-17% treated by ET, and 8-11% treated by PCS. Shunt stenosis or occlusion occurred in 67% of TIPS patients, in contrast with 0-2% of PCS patients. |
1 |
| 74. Henderson JM, Boyer TD, Kutner MH, et al. Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial. Gastroenterology. 2006;130(6):1643-1651. |
Experimental-Tx |
140 patients |
To test the hypothesis that patients receiving distal splenorenal shunt (DSRS) would have significantly lower rebleeding and encephalopathy rates than transjugular intrahepatic portal systematic shunts (TIPS) in management of refractory variceal bleeding. |
No significant difference in rebleeding (DSRS 5.5%; TIPS 10.5%; P=.29) or first encephalopathy event (DSRS 50%; TIPS 50%). Survival at 2 and 5 years (DSRS 81% and 62% TIPS, 88% and 61%, respectively) were not significantly different (P=.87). Thrombosis, stenosis, and reintervention rates (DSRS 11%; TIPS 82%) were significantly (P<.001) higher in the TIPS group. Ascites, need for transplant, quality of life, and costs were not significantly different. |
1 |
| 75. Su AP, Zhang ZD, Tian BL, Zhu JQ. Transjugular intrahepatic portosystemic shunt versus open splenectomy and esophagogastric devascularization for portal hypertension with recurrent variceal bleeding. Hepatobiliary Pancreat Dis Int. 2017;16(2):169-175. |
Observational-Tx |
196 patients |
To compare the effectiveness between TIPS and OSED for the treatment of PHRVB. METHODS: The data were retrospectively retrieved from 479 cirrhotic patients (Child-Pugh A or B class) with PHRVB, who had undergone TIPS (TIPS group) or OSED (OSED group) between January 1, 2010 and October 31, 2014. |
A total of 196 patients received TIPS, whereas 283 underwent OSED. Within one month after TIPS and OSED, the rebleeding rates were 6.1% and 3.2%, respectively (P=0.122). Significantly lower incidence of pleural effusion, splenic vein thrombosis, and pulmonary infection, as well as higher hepatic encephalopathy rate, shorter postoperative length of hospital stay, and higher hospital costs were observed in the TIPS group than those in the OSED group. During the follow-up periods (29 months), significantly higher incidences of rebleeding (15.3% vs 4.6%, P=0.001) and hepatic encephalopathy (17.3% vs 3.9%, P=0.001) were observed in the TIPS group than in the OSED group. The incidence of in-stent stenosis was 18.9%. The survival rates were 91.3% in the TIPS group and 95.1% in the OSED group. The long-term liver function did not worsen after either TIPS or OSED. |
2 |
| 76. Cheng Z, Li JW, Chen J, Fan YD, Guo P, Zheng SG. Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases. J Laparoendosc Adv Surg Tech A. 2014;24(9):612-616. |
Review/Other-Tx |
188 patients |
To investigate the effects and technical points of laparoscopic splenectomy and esophagogastric devascularization (LS+ED) for portal hypertension (PH) due to liver cirrhosis. |
LS+ED was successfully carried out on 188 patients. The mean duration of surgery was 232+/-59 minutes, the mean intraoperative blood loss was 189+/-137 mL, the rate of blood transfusion was 19.6% (40/204), and no deaths occurred during surgery. The mean postoperative interval to passing of flatus was 3.5+/-0.9 days, and the mean postoperative hospital stay was 8.7+/-2.2 days. Operative complications occurred in 100 patients, of whom 78 had portal vein system thrombosis (PVST). During a postoperative follow-up period of 2-65 months, 15 cases were lost to follow-up, esophagogastric variceal bleeding re-occurred in 7 patients, encephalopathy occurred in 2 patients, and secondary liver cancer occurred in 3 patients. Five patients died during this period. |
4 |
| 77. Feng LS, Chen XP. Combined splenocaval or mesocaval C shunt and portoazygous devascularization in the treatment of portal hypertension: analysis of 150 cases. Hepatobiliary Pancreat Dis Int. 2006;5(1):70-73. |
Review/Other-Tx |
150 patients |
To investigate the effects of combined splenocaval or mesocaval C shunt and portoazygous devascularization (combined procedures) on portal hypertension. |
The mean free portal pressure (FPP) was 25.6+/-1.83 mmHg, 18.0+/-2.07 mmHg and 18.4+/-2.19 mmHg before operation, after splenectomy plus splenocaval or mesocaval C shunt, and combined procedures, respectively. There was no operative death in all patients. The 1-7 year follow-up of 100 patients showed rebleeding in 3 patients, encephalopathy in 4, thrombosis of artificial vascular graft in 3, and dying from liver failure in 2. |
4 |
| 78. Reverter E, Tandon P, Augustin S, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterology. 2014;146(2):412-419 e413. |
Review/Other-Tx |
178 patients |
To improve determination of risk for patients with acute variceal bleeding (AVB). |
Among study subjects, the 6-week mortality rate was 16%. MELD was the best model in terms of discrimination; it was recalibrated to predict the 6-week mortality rate with logistic regression (logit, -5.312 + 0.207 * MELD; bootstrapped R(2), 0.3295). MELD values of 19 or greater predicted 20% or greater mortality, whereas MELD scores less than 11 predicted less than 5% mortality. The model performed well for patients from Canada at all risk levels. In the Spanish validation set, in which all patients were treated with banding ligation, MELD predictions were accurate up to the 20% risk threshold. |
4 |
| 79. Spengler EK, Hunsicker LG, Zarei S, Zimmerman MB, Voigt MD. Transjugular intrahepatic portosystemic shunt does not independently increase risk of death in high model for end stage liver disease patients. Hepatol Commun. 2017;1(5):460-468. |
Observational-Tx |
106 patients |
To determine if TIPS increased the risk of death in these patients. |
We found a negative interaction between a high MELD score and a history of TIPS, with potentially important effect sizes. Patients with MELD scores >/=18 had a 51% lower incremental risk of death (lower risk than would be expected from the combined independent risks of MELD and needing/receiving TIPS) associated with TIPS than patients with MELD scores <18 (hazard ratio for TIPS, 0.49; 95% confidence interval, 0.10-2.45) in the first 6 months following TIPS. There was an 80% lower incremental risk of death among patients with a MELD score >/=18 (hazard ratio for TIPS, 0.20; 95% confidence interval, 0.03-1.23) 6 months after the TIPS procedure. |
2 |
| 80. Saad WE, Wagner CC, Al-Osaimi A, et al. The effect of balloon-occluded transvenous obliteration of gastric varices and gastrorenal shunts on the hepatic synthetic function: a comparison between Child-Pugh and model for end-stage liver disease scores. Vasc Endovascular Surg. 2013;47(4):281-287. |
Observational-Tx |
26 patients |
To evaluate the effect of balloon-occluded transvenous obliteration (BRTO) on the model for end-stage liver disease (MELD) and the Child-Pugh (C-P) score and their individual components. |
A total of 29 consecutive successful BRTO procedures were found and assessed. In all, 26 had immediate post-BRTO sampling (average 1.8 days after BRTO), 13 (57%) had an early post-BRTO sampling (average 47 days from BRTO), and 10 (38%) had a delayed post-BRTO sampling (average 121 days from BRTO). The bilirubin rises significantly (P = .007) within days after BRTO, but synthetic function improves significantly between 1.5 and 4.0 months post-BRTO (international normalized ration: P = .02, bilirubin: P = .027, and albumin: P = .012). However, 31% (N = 8/ 26) of the patients had worsening ascites with or without hydrothorax. The MELD score significantly improved circa 4 months post-BRTO (from 14.1 to 10.7, P = .0008). However, the C-P score did not change significantly (from 7.6 to 6.7, P = .063). |
2 |
| 81. Miraglia R, Maruzzelli L, Tuzzolino F, Petridis I, D'Amico M, Luca A. Transjugular Intrahepatic Portosystemic Shunts in Patients with Cirrhosis with Refractory Ascites: Comparison of Clinical Outcomes by Using 8- and 10-mm PTFE-covered Stents. Radiology. 2017;284(1):281-288. |
Observational-Tx |
171 patients |
To compare the efficacy and complications of transjugular intrahepatic portosystemic shunt (TIPS) creation performed by using a 10-mm or an 8-mm-diameter polytetrafluoroethylene (PTFE)-covered stent in a consecutive series of patients with cirrhosis with refractory ascites (RA). |
Pre-TIPS demographics and clinical characteristics of the two groups were comparable. The portosystemic gradient before TIPS was 17.0 mm Hg +/- 4.2 (95% CI: 15.9 mm Hg, 18.1 mm Hg) in the 10-mm group versus 16.1 mm Hg +/- 3.7 (95% CI: 15.4 mm Hg, 16.8 mm Hg) in the 8-mm group (P = .164). After TIPS, the portosystemic gradient was 6.5 mm Hg +/- 3.4 (95% CI: 5.7 mm Hg, 7.4 mm Hg) in the 10-mm group versus 7.5 mm Hg +/- 2.6 (95% CI: 6.9 mm Hg, 7.9 mm Hg) in the 8-mm group (P = .039). The long-term need for paracentesis was greater in the 8-mm group (64 of 111 patients [58%] vs 18 of 60 patients [31%], P = .003). Overall, hepatic encephalopathy was similar in both groups (45 of 111 patients [41%] vs 26 of 60 patients [44%], P = .728). |
2 |
| 82. Quintini C, D'Amico G, Brown C, et al. Splenic artery embolization for the treatment of refractory ascites after liver transplantation. Liver Transpl 2011;17:668-73. |
Review/Other-Tx |
6 patients |
To describe our experience with splenic artery embolization (SAE) for the treatment of refractory ascites (RA). |
The PV (portal vein) velocity decreased significantly for each patient after the embolization (median = 66.5 cm/second before SAE and median = 27.5 cm/second after SAE, P < 0.01). All patients experienced a significant postprocedural weight loss (mean = 88.1 +/- 28.4 kg before SAE and mean = 75.8 +/- 28.4 kg after SAE, P < 0.01) and a dramatic decrease in their diuretic requirements. All but 1 of the patients experienced a complete resolution of ascites after a median time of 49.5 days (range = 12-295 days). No patient presented with postembolization complications. |
4 |
| 83. Madoff DC, Wallace MJ, Ahrar K, Saxon RR. TIPS-related hepatic encephalopathy: management options with novel endovascular techniques. Radiographics. 2004;24(1):21-36; discussion 36-27. |
Review/Other-Tx |
N/A |
Review management options for TIPS- related hepatic encephalopathy. |
Further research needed to improve understanding of TIPS-related hepatic encephalopathy so that newer, less invasive and safer procedures can be developed. |
4 |
| 84. Yoshida H, Mamada Y, Taniai N, et al. Long-term results of partial splenic artery embolization as supplemental treatment for portal-systemic encephalopathy. Am J Gastroenterol 2005;100:43-7. |
Observational-Tx |
25 patients |
To present long-term results of angiographic partial splenic artery embolization (PSE) as a supplemental treatment of portal-systemic encephalopathy. |
Portal venous pressures pretreatment was similar to posttreatment in the PSE(+) group, but lower than posttreatment in the PSE(-) group. Serum ammonia levels were higher at pretreatment than at 1 wk posttreatment in both groups, but the levels in the two groups were similar at pretreatment, 1 wk, 3 months, 3 yr, 4 yr, and 5 yr posttreatment. However, serum ammonia levels were lower in the PSE(+) group than in the PSE(-) group 6 months, 9 months, 1 yr, and 2 yr posttreatment. Grades of encephalopathy were higher at pretreatment than at 1 wk posttreatment in both groups, but the levels in the two groups were similar at pretreatment, 1 wk, 2 yr, 3 yr, 4 yr, and 5 yr posttreatment. However, grades of encephalopathy were lower in the PSE(+) group than in the PSE(-) group 3 months, 6 months, 9 months, and 1 yr posttreatment. |
2 |
| 85. Choi YS, Lee JH, Sinn DH, et al. Effect of balloon-occluded retrograde transvenous obliteration on the natural history of coexisting esophageal varices. J Clin Gastroenterol. 2008;42(9):974-979. |
Observational-Tx |
237 patients |
To determine whether the natural history of coexisting esophageal varices (EV) is affected by balloon-occluded retrograde transvenous obliteration (BRTO). |
The BRTO and control groups were not significantly different with respect to baseline characteristics including age, sex, etiologies of cirrhosis, hepatic function, and the classification or extent of EV and GV. During follow-up (median 48 mo), the overall incidence of first EV bleeding in the patients with fundal varices was significantly higher in the BRTO group (P=0.04). The incidences of EV bleeding were not different at 1 or 3 years (10.1% vs. 12.9%, P=0.32 and 39.3% vs. 38.4%, P=0.57), but became significantly higher in the BRTO group at 5 (72.2% vs. 48.5%, P=0.02) and 7 years (90.7% vs. 50.6%, P<0.01). |
2 |
| 86. Watanabe K, Kimura K, Matsutani S, Ohto M, Okuda K. Portal hemodynamics in patients with gastric varices. A study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology 1988;95:434-40. |
Observational-Dx |
230 patients |
To investigate the nature of hepatofugal collateral veins, their origins, the direction of blood flow in the major veins and collateral veins, and portal venous pressure |
Gastric varices were seen in 57% of the patients with varices due to portal hypertension. In most of the patients with advanced gastric varices, esophageal varices were minimal or absent. When patients with gastric varices were compared with those having predominantly esophageal varices, it was found that advanced gastric varices were more frequently supplied by the short and posterior gastric veins, they were almost always associated with large gastrorenal shunts, and portal venous pressure in patients with large gastric varices was lower. Chronic portal systemic encephalopathy was more common in patients with large gastric varices due to hepatofugal flow of superior mesenteric venous blood in the splenic vein than in patients with predominantly esophageal varices. Thus, the hemodynamics in patients with large gastric varices are distinctly different from those in patients with mainly esophageal varices, and such differences seem to account for the differing incidence of chronic encephalopathy and variceal bleeding. |
2 |
| 87. Xu CE, Zhang SG, Yu ZH, et al. Combined devascularization and proximal splenorenal shunt: is this a better option than either procedure alone? J Hepatobiliary Pancreat Surg. 2004;11(2):129-134. |
Observational-Tx |
99 Patients |
To determine the rationality of pericardial devascularization (PCDV) plus proximal splenorenal shunt (PSRS) for cirrhotic patients with portal hypertension with variceal bleeding, using a duplex sonography study of the effects of the different surgical procedures (PCDV, PSRS, and PCDV + PSRS) on the hemodynamics of the portal system. |
In the PSRS group, the postoperative portal venous flow (PVF) and free portal pressure (FPP) decreased by 57 +/- 9% and 52 +/- 5%, respectively (P < 0.01). In the PCDV group, the postoperative PVF lessened by 8 +/- 5% (P > 0.05), and the postoperative FPP was reduced by 19 +/- 7% (P < 0.05). In the PCDV + PSRS group, the postoperative PVF and FPP were lowered by 36 +/- 8% and 34 +/- 10%, respectively (P < 0.05). The postoperative decreases of PVF and FPP in the PCDV + PSRS group were between those of the PSRS and PCDV groups. The differences among these groups were statistically significant (P < 0.05). |
3 |
| 88. Ono Y, Matsueda K, Koga R, et al. Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation. Br J Surg. 2015;102(3):219-228. |
Review/Other-Tx |
103 patients |
To analyse the pathogenesis of sinistral portal hypertension following splenic vein ligation in pancreaticoduodenectomy. |
Of 103 patients who underwent pancreaticoduodenectomy with portal vein resection, 43 had splenic vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater splenic hypertrophy than the non-varicose route (median splenic hypertrophy ratio 1.52 versus 0.94; P < 0.001). All patients with the varicose route had colonic varices, and none had a right colic marginal vein at the hepatic flexure. |
4 |
| 89. Liu Q, Song Y, Xu X, Jin Z, Duan W, Zhou N. Management of bleeding gastric varices in patients with sinistral portal hypertension. Dig Dis Sci. 2014;59(7):1625-1629. |
Review/Other-Tx |
21 patients |
To summarize our experience in managing GV bleeding from SPH in patients with pancreatic diseases. |
Twenty-one patients (15.2 %) complicating bleeding GVs among 139 patients with SPH secondary to pancreatic diseases were enrolled. The etiologies were acute pancreatitis in one patient, chronic pancreatitis in seven patients, and pancreatic tumors in 13 patients. Emergent endoscopic sclerotherapy was initially performed in five patients, and succeeded in two patients, while one patient died of massive hemorrhage. Initial transcatheter artery embolization using Gianturco coils was successfully performed in six patients. Splenectomy combined with other surgical procedures was undertaken for 15 patients. The patients undergoing artery embolization or splencetomy achieved hemostasis. The survivors had no recurrent bleeding during a median 72-month follow-up period. |
4 |
| 90. Sato T, Yamazaki K, Akaike J, Toyota J, Karino Y, Ohmura T. Clinical and endoscopic features of gastric varices secondary to splenic vein occlusion. Hepatol Res. 2008;38(11):1076-1082. |
Review/Other-Tx |
14 patients |
To discuss a retrospective evaluation of cases with gastric varices secondary to splenic vein occlusion. |
Eleven patients had co-existing pancreatic diseases: seven with chronic pancreatitis, three with cancer of the pancreatic body or tail and one with severe acute pancreatitis. Among the three remaining patients, one had advanced left renal cancer, one had myeloproliferative disease and the third had splenic vein occlusion due to an obscure cause. A diagnosis of gastric varices was made following endoscope gastroduodenoscopy or endoscopic color Doppler ultrasonography (ECDUS), and splenic vein occlusions were diagnosed from enhanced computed tomography in all cases. Specific findings of gastric varices secondary to splenic vein occlusion were based on ECDUS color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body. For three cases with gastric variceal bleeding, endoscopic injection sclerotherapy using a mixture of histoacryl and lipiodol (70% histoacryl solution) was performed, after which no further bleeding from gastric varices was detected. Due to a high risk of gastric variceal rupture, splenectomy was performed in two cases and splenic arterial embolization in another two cases. |
4 |
| 91. Janne d'Othee B, Walker TG, Marota JJ, Waltman AC, Greenfield AJ, Koizumi J. Splenic venous congestion after balloon-occluded retrograde transvenous obliteration of gastric varices. Cardiovasc Intervent Radiol 2012;35:434-8. |
Review/Other-Tx |
1 male with hepatic cirrhosis |
To report a case of BRTO of extremely large gastric varices in the presence of partial splenoportal thrombosis (in which post procedural computed tomography (CT) appearance and clinical evolution suggested increased regional venous pressure and parenchymal splenic congestion). |
No results stated in abstract |
4 |
| 92. Saad WE, Kitanosono T, Koizumi J, Hirota S. The conventional balloon-occluded retrograde transvenous obliteration procedure: indications, contraindications, and technical applications. Tech Vasc Interv Radiol 2013;16:101-51. |
Review/Other-Tx |
N/A |
To review the indications, contraindications, and technical considerations of the conventional balloon-occluded retrograde transvenous obliteration (BRTO) procedure. |
No results stated in abstract. |
4 |
| 93. Luo X, Nie L, Wang Z, Tsauo J, Tang C, Li X. Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertension complicated by gastrointestinal bleeding. Cardiovasc Intervent Radiol. 37(1):108-13, 2014 Feb. |
Review/Other-Tx |
11 patients |
To evaluate the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to regional portal hypertension (RPH). |
Technical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 +/- 7.3 to 2.9 +/- 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3-34) months, no recurrence of GI bleeding was observed. |
4 |
| 94. Wang Q, Xiong B, Zheng C, Liang M, Han P. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients. Cardiovasc Intervent Radiol. 39(3):353-8, 2016 Mar. |
Review/Other-Tx |
14 patients |
To report our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding. |
In 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up. |
4 |
| 95. Sakorafas GH, Sarr MG, Farley DR, Farnell MB. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg. 2000;179(2):129-133. |
Review/Other-Tx |
484 patients |
To determine appropriate surgical strategoes for patients with splenic vein thrombosis/obstruction secondary to chronic pancreatitis. |
Sinistral portal hypertension was present in 34 of the 484 patients (7%). Gastric or gastroesophageal varices were confirmed in 12 patients (35%), of whom 6 had variceal bleeding and 4 had hypersplenism (25%). All symptomatic patients were treated by splenectomy alone or in conjunction with distal pancreatectomy. Splenectomy at the time of pancreatectomy for primary pancreatic symptoms was also performed in 15 patients with (asymptomatic) sinistral portal hypertension. None of the 23 patients who had splenectomy rebled in mean follow-up of 4.8 years. In contrast, 1 of the 11 patients with asymptomatic sinistral portal hypertension who underwent pancreatic surgery without splenectomy died of later variceal bleeding 3 years after lateral pancreatojejunostomy. |
4 |
| 96. Loftus JP, Nagorney DM, Ilstrup D, Kunselman AR. Sinistral portal hypertension. Splenectomy or expectant management. Ann Surg. 1993;217(1):35-40. |
Observational-Tx |
37 patients |
To further define the role of splenectomy for sinistral portal hypertension (SPH), the authors compared the clinical presentations and outcomes of 25 patients treated with splenectomy with those of 12 observed patients. |
At 3 years, neither survival (78% vs. 64%, p = 1.0) nor new or recurrent bleeding (16% vs. 24%, p = 0.2) differed, splenectomy versus no splenectomy, respectively. |
2 |
| 97. Uflacker R. Applications of percutaneous mechanical thrombectomy in transjugular intrahepatic portosystemic shunt and portal vein thrombosis. Tech Vasc Interv Radiol 2003;6:59-69. |
Review/Other-Tx |
N/A |
To discuss the application of mechanical thrombectomy (MT) in patients with portal vein thrombosis (PVT). |
No results stated in abstract. |
4 |
| 98. Thornburg B, Desai K, Hickey R, et al. Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis: Technical Considerations. Tech Vasc Interv Radiol. 2016;19(1):52-60. |
Review/Other-Tx |
61 patients |
To describe in detail our approach to PVR-TIPS with a focus on the transsplenic method. |
After transitioning to transsplenic access to assist with recanalization, the technical success rate has improved to 100%. The recanalized portal vein and TIPS have maintained patency during follow-up, or to the time of transplant, in 55 patients (92%) with a mean follow-up of 16.7 months. In total, 23 patients (38%) have undergone transplant, all of whom received a physiologic anastomosis (end-to-end anastomosis in 22 of 23 patients, 96%). |
4 |
| 99. Luo J, Li M, Zhang Y, et al. Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding with chronic portal vein occlusion after splenectomy. Eur Radiol 2018;28:3661-68. |
Observational-Tx |
24 patients with chronic portal vein occlusion (CPVO) |
To introduce a modified transjugular intrahepatic portosystemic shunt (TIPS), a percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS), and to evaluate its feasibility and efficacy in patients with variceal bleeding with chronic portal vein occlusion (CPVO) after splenectomy. |
PTIPS was successfully placed in 22 patients (91.7%) and failed in two. The mean PPG fell from 22.0 ± 4.9 mmHg to 10.6 ± 1.6 mmHg after successful PTIPS (p < 0.05). No fatal procedural complications occurred. During the median follow-up of 29 months, shunt dysfunction occurred in five cases and hepatic encephalopathy in four cases. Three patients died because of rebleeding, hepatic failure and pulmonary disease, respectively. The other patients remained asymptomatic and the shunts patent. |
2 |
| 100. Luo X, Wang Z, Tsauo J, Zhou B, Zhang H, Li X. Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding. Radiology 2015;276:286-93. |
Experimental-Tx |
73 patients |
To compare transjugular intrahepatic portosystemic shunt (TIPS) placement with or without variceal embolization with endoscopic band ligation (EBL) plus propranolol in preventing recurrent esophageal variceal bleeding in patients with advanced cirrhosis and portal vein thrombosis. |
The mean follow-up time was 22.8 months 6 7.7(standard deviation) in the TIPS group and 20.9 months ± 8.9 in the EBL group. The 2-year probability of remaining free of recurrent variceal bleeding was higher in the TIPS group (77.8%) than in the EBL group (42.9%) (P = .002). Overall recanalization was achieved in 24 (64.9%) patients from the TIPS group and seven (19.4%) patients from the EBL group. The hepatic encephalopathy rates exhibited no significant differences between the two groups (P = .53). The 1- and 2-year probability of survival was 86.5% and 72.9%, respectively, in the TIPS group and 83.3% and 57.2%, respectively, in the EBL group, with no significant difference (P = .23). |
1 |
| 101. Han GH, Meng XJ, Yin ZX, et al. [Transjugular intrahepatic portosystemic shunt and combination with percutaneous transhepatic or transsplenic approach for the treatment of portal vein thrombosis with or without cavernomatous transformation]. Zhonghua Yi Xue Za Zhi 2009;89:1549-52. |
Observational-Tx |
65 patients with portal vein thrombosis |
To evaluate retrospectiv ely the feasibility, efficacy and safety of transjuglar intrahepatic portosystemic shunt (TIPS) or percutaneous transhepatic or transsplenic approach to the portal vein with the combination of TIPS for the treatment of patients with portal vein thrombosis with or without cavernous transformation. |
TIPS were successfully created in 54 of 65 patients with portal vein thrombosis with a success rate of 83.1 % . Among them, TIPS were performed directly in 36 of 40 patients; portal vein recanalization were successfully performed via transhepatic access in 15 of 25 patients, and 3 of remaining 5 who failed the transhepatic approach were successfully done from transsplenic access. Then TIPS placement was accomplished with a success rate of 72.0% (18/25). The success rate in cirrhotic patients was 82. 4% (42/51) and it was not significant different from those without cirrhosis 85. 7% (12/14) (P =0.766). While the success rate in the patients with cavernous transformation 71.8% (28/39) showed a significant difference compared to that without cavernous transformation l00% (26/26) (P = 0.002). The success rates in portal vein thrombosis and cavernous transformation with or without cirrhosis were 42.9% (18/42) and 83.3% (10/12) respectively, exhibiting a significant difference (P = 0.021). The mortality rate of 30 days post-operation was 3.7% (2/54). From Day 1 to 63 months follow-up, the incidence rate of hepatic encephalopathy was 27.8% (15/54); revision rate 22.2% (12/54); median survival time 31.4 months. |
2 |
| 102. Walser EM, Soloway R, Raza SA, Gill A. Transjugular portosystemic shunt in chronic portal vein occlusion: importance of segmental portal hypertension in cavernous transformation of the portal vein. J Vasc Interv Radiol. 2006;17(2 Pt 1):373-378. |
Review/Other-Tx |
1 patient |
To describe a patient with bleeding varices due to chronic portal vein occlusion. |
A transjugular intrahepatic portosystemic shunt (TIPS) attempt failed because of cannulation of a low-pressure network of portal veins, which communicated only with the chronically thrombosed native portal vein. A second TIPS attempt was successful after transhepatic catheterization of a high-pressure portal system that was continuous with periportal collateral veins and mesenteric veins. After 8 months and one TIPS revision for hepatic vein stenosis, the patient has improved liver function, collapsed varices, and a patent TIPS on ultrasonogram. |
4 |
| 103. Wils A, van der Linden E, van Hoek B, Pattynama PM. Transjugular intrahepatic portosystemic shunt in patients with chronic portal vein occlusion and cavernous transformation. J Clin Gastroenterol. 2009;43(10):982-984. |
Review/Other-Tx |
4 patients |
To determine the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) creation as a possible salvage intervention in patients with variceal bleeding and chronic portal vein thrombosis with cavernous transformation, refractory to endoscopic therapy. |
Creation of TIPS to the dilated veins of a cavernous transformation was feasible in patients for whom recanalization of the portal vein was not possible. However, the collaterals need to be suitably wide for placement of TIPS and the high-pressure collaterals should communicate with the varices. |
4 |
| 104. Marot A, Barbosa JV, Duran R, Deltenre P, Denys A. Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion. Diagn Interv Imaging 2018. |
Observational-Tx |
15 non-cirrhotic patients |
The purpose of this study was to evaluate the feasibility, safety, and efficacy of portalvein recanalization (PVR) and propose a new classification for better selecting candidates with portal vein occlusion (PVO) in whom PVR could be feasible. |
There were 6 patients with PVO type 1, 7 patients with PVO type 2, and 2 patients with PVO type 3. Indications for PVR were gastrointestinal bleeding (n = 6), portal biliopathy (n = 2), reduce portal pressure before surgery (n = 4), or other (n = 3). PVR was successful in 13 patients (87%) with no severe side effects. Failure of PVR or early stent thrombosis occurred in 100% of type 3 vs. 8% of type 1 and 2 patients (P = 0.03). During a mean follow-up of 42 ±28 months (range: 6—112 months), patients with a permeable stent had resolution of portal hypertension-related manifestations. In 13 patients in whom PVR was feasible, stent permeability was 77% at 2 years (87% vs. 60% in patients who received anti-coagulation or not, respectively; P = 0.3). |
2 |
| 105. Qi X, Han G, Yin Z, et al. Transjugular intrahepatic portosystemic shunt for portal cavernoma with symptomatic portal hypertension in non-cirrhotic patients. Dig Dis Sci 2012;57:1072-82. |
Observational-Tx |
21 patients |
To evaluate the feasibility, safety, and efficacy of TIPS for symptomatic portal hypertension in non-cirrhotic patients with portal cavernoma. |
TIPS were successfully placed in 35% (7/20) of patients via a transjugular approach alone (n = 1), a combined transjugular/transhepatic approach (n = 4), and a combined transjugular/transsplenic approach (n = 2). TIPS were inserted in a large collateral vein in two patients in whom recanalization of the occluded main portal vein was impossible. Procedure-related complication was hepatic capsule perforation in one patient who was cured by medical therapy alone. Shunt dysfunction occurred in two patients, but TIPS revision was failed in one of them. Portosystemic pressure gradient was significantly reducedin TIPS success group (26.3 ± 1.1 vs. 12.4 ± 1.1 mmHg, p\0.001). The incidence of variceal bleeding in TIPS success group is lower than that in TIPS failure group (14 vs. 69%, p = 0.057). In TIPS success group, two patients died of systemic infection and accident, respectively. In TIPS failure group, two patients died of liver failure. |
2 |
| 106. Klinger C, Riecken B, Schmidt A, et al. Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis. Z Gastroenterol 2018;56:221-37. |
Observational-Tx |
17 patients with portal vein thrombosis |
To evaluate efficacy and safety of portal vein recanalization in combination with transjugular intrahepatic portosystemic shunt creation (PVRTIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT). |
Recanalization was successful in 76.5 % of patients despite cavernous transformation in 88.2 %. Both 1- and 2-year secondary PV and TIPS patency rates were 69.5 %. Procedure- related bleeding complications occurred in 2 patients (intraperitoneal bleeding due to capsule perforation, n = 1; liver hematoma, n = 1) and resolved spontaneously. However, 1 patient died due to subsequent nosocomial pneumonia. During follow-up, 3 patients with TIPS occlusion and PVT recurrence experienced portal hypertensive complications. |
2 |
| 107. Borghei P, Kim SK, Zuckerman DA. Balloon occlusion retrograde transvenous obliteration of gastric varices in two non-cirrhotic patients with portal vein thrombosis. Korean J Radiol. 2014;15(1):108-113. |
Review/Other-Tx |
2 patients |
To describe two non-cirrhotic patients with portal vein thrombosis who underwent successful balloon occlusion retrograde transvenous obliteration (BRTO) of gastric varices with a satisfactory response and no complications. |
The BRTO procedure was a useful treatment for gastric varices in non-cirrhotic patients with portal vein thrombosis in the presence of a gastrorenal shunt. |
4 |
| 108. Miyaaki H, Ichikawa T, Nakao K, et al. Portal hypertensive gastropathy with portal thrombosis successfully treated with partial splenic embolization. Clin J Gastroenterol. 2009;2(3):218-221. |
Review/Other-Tx |
1 patient |
To describe our experience with a 60-year-old man with alcoholic liver cirrhosis who was admitted to our hospital with severe anemia and tarry stool. |
Two months after PSE was performed, upper gastrointestinal endoscopy showed improvement of PHG and endoscopic variceal ligation was performed to treat the esophageal varices. Contrast-enhanced CT revealed partial enhancement of the main portal vein indicating improvement of portal thrombosis. One year after PSE, hemoglobin had increased from 6.0 to 11.0 g/dl without blood transfusion. Moreover, albumin level had risen from 2.8 to 3.7 g/dl, cholinesterase from 51 to 150 IU/l, and prothrombin time from 47% to 66%. |
4 |
| 109. Wang RY, Wang JF, Liu Q, Ma N, Chen WX, Li JL. Combined Rex-bypass shunt with pericardial devascularization alleviated prehepatic portal hypertension caused by cavernomatous transformation of portal vein. Postgrad Med. 2017;129(7):768-776. |
Review/Other-Tx |
42 patients |
To evaluate the effects of combined Rex-bypass shunt and pericardial devascularization on prehepatic portal hypertension secondary to cavernomatous transformation of portal vein (CTPV). |
No intraoperative death occurred, blood routine analysis improved (P < 0.05), the blood flow velocity (P < 0.05) and diameter (P < 0.05) of the left portal vein (LPV) significantly increased, the esophageal and gastric varices significantly relieved in 34 patients (P < 0.05), and better effects of earlier operations were demonstrated than the delayed ones (P < 0.05). During the period of follow-up from 6 to 64 months, the overall patency rate was 85.7% and the younger the age the better of the effect. |
4 |
| 110. Zhang H, Zhang N, Li M, Jin W, Pan S. Surgical treatment of portal vein cavernous transformation. World J Surg. 2004;28(7):708-711. |
Review/Other-Tx |
18 patients |
To explore the treatment of portal cavernous transformation (PVCT). The surgical treatment of 18 patients with PVCT was studied retrospectively. |
Eight patients underwent mesocaval shunt with artificial grafts, two patients had splenectomy and disconnection, three patients had a central splenorenal shunt, and six patients had a distal splenorenal shunt. There were no deaths or hepatic encephalopathy after operation. Bleeding recurred in two patients (disconnection in one, mesocaval shunt in one). |
4 |
