OBJECTIVE: The purpose of our study was to investigate the frequency and outcomes of partial thrombosis of gastric varices after balloon-occluded retrograde transvenous obliteration (BRTO). MATERIALS AND METHODS: We reviewed retrospectively 69 consecutive patients with gastric varices who were followed-up for > 6 months after treatment with BRTO. All patients underwent contrast-enhanced CT and gastroscopy before and after BRTO. Imaging findings of gastric varices with particular attention to afferent veins, degree of thrombosis, and variceal changes were investigated. RESULTS: On the basis of pretherapeutic CT images, gastric varices were classified into two types: simple (< 3 afferent veins) and complex (≥ 3 afferent veins). Initial follow-up CT showed complete thrombosis in 58 patients (84%) and partial thrombosis in 11 (16%). Partial thrombosis was observed more frequently in complex-type varices (25% vs 9%). No regrowth or recurrent varices were observed in completely thrombosed varices. Follow-up endoscopy showed regrowth of gastric varices at 6-24 months after BRTO in five patients; all of these were complex-type and partially thrombosed varices. All five recurrent varices were treated successfully with repeated BRTO. CONCLUSION: Partial thrombosis after BRTO can occur in complex-type gastric varices, which have a higher risk of regrowth. Additional techniques that achieve complete thrombosis are required for long-term efficacy for complex-type gastric varices.
OBJECTIVE: The purpose of our study was to investigate the frequency and outcomes of partial thrombosis of gastric varices after balloon-occluded retrograde transvenous obliteration (BRTO). MATERIALS AND METHODS: We reviewed retrospectively 69 consecutive patients with gastric varices who were followed-up for > 6 months after treatment with BRTO. All patients underwent contrast-enhanced CT and gastroscopy before and after BRTO. Imaging findings of gastric varices with particular attention to afferent veins, degree of thrombosis, and variceal changes were investigated. RESULTS: On the basis of pretherapeutic CT images, gastric varices were classified into two types: simple (< 3 afferent veins) and complex (≥ 3 afferent veins). Initial follow-up CT showed complete thrombosis in 58 patients (84%) and partial thrombosis in 11 (16%). Partial thrombosis was observed more frequently in complex-type varices (25% vs 9%). No regrowth or recurrent varices were observed in completely thrombosed varices. Follow-up endoscopy showed regrowth of gastric varices at 6-24 months after BRTO in five patients; all of these were complex-type and partially thrombosed varices. All five recurrent varices were treated successfully with repeated BRTO. CONCLUSION: Partial thrombosis after BRTO can occur in complex-type gastric varices, which have a higher risk of regrowth. Additional techniques that achieve complete thrombosis are required for long-term efficacy for complex-type gastric varices.
Authors: Jonathan K Park; Sammy Saab; Stephen T Kee; Ronald W Busuttil; Hyun J Kim; Francsico Durazo; Sung-Ki Cho; Edward Wolfgang Lee Journal: Dig Dis Sci Date: 2014-12-18 Impact factor: 3.199