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ORIGINAL ARTICLES  
CMH 2012 December;18:368-374.
Published online 2012 December 24. doi:http://dx.doi.org/10.3350/cmh.2012.18.4.368
Copyright © 2012 The Korean Association for the Study of the Liver
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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
Se Young Jang1*, Go Heun Kim2*, Soo Young Park1, Chang Min Cho1, Won Young Tak1, Jeong Han Kim2, Won Hyeok Choe2, So Young Kwon2, Jae Myeong Lee3, Sang Gyune Kim3, Dae Yong Kim3, Young Seok Kim3, Se-Ok Lee4, Yang Won Min4, Joon Hyeok Lee4, Seung Woon Paik4, Byung Chul Yoo4, Jae Wan Lim5, Hong Joo Kim5, Yong Kyun Cho5, Joo Hyun Sohn6, Jae Yoon Jeong6, Yu Hwa Lee6, Tae Yeob Kim6, and Young Oh Kweon1
1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu; 2Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul & Choongju; 3Department of Internal Medicine & Radiology, Soonchunhyang University College of Medicine, Bucheon; 4Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; 5Department of Internal Medicine, Kangbook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; 6Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea
Corresponding Author: Young Oh Kweon ,Tel: +82-53-420-5515, Fax: +82-53-426-8773, Email: yokweon@mail.knu.ac.kr
ABSTRACT
Background/Aims: This study evaluated 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).
Methods: We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 universitybased hospitals between January 2001 and December 2010.
Results: 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 36.029.2 months (meanSD) 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).
Conclusions: BRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.
Keywords: Balloon-occluded retrograde transvenous obliteration; Esophageal varices; Gastric varices; Liver cirrhosis; Variceal hemorrhage
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