Short and long term outcomes of Balloon-occluded Retrograde Transvenous Obliteration (BRTO) in gastric varices patients: A retrospective analysis

Abstract Background: Gastric variceal bleeding is one of the major complications of portal hypertension and is associated with high morbidity and mortality. This study aimed to evaluate the clinical outcomes of BRTO in gastric varices patients. Methods: Retrospective single-center study included 36 patients with moderate to large gastric varices who referred to intervention radiology for balloon-occluded retrograde transvenous obliteration (BRTO) procedure from January 2007 to December 2019. Short and long post procedural outcomes were analyzed for rebleeding, recurrence of gastric varices, worsening of esophageal varices, and mortality. Results: The mean age of the patients was 53.42 ± 9.8 years. Of the 36 patients, 30 (83.3%) were male. The majority of them had diabetes mellitus (21, 58.3%), hypertension (13, 36.1%), and coronary artery disease (3, 8.3%). Hepatitis C virus infection (15, 41.7%) was the predominant cause of liver cirrhosis. The follow-up CT showed immediate hemostasis in all patients except 2 (5.6%), who had hypovolemic shocks. Recurrence of gastric varices were observed in 4 (11.11%) patients, esophageal varices in 2 (5.55%) and both in 1 (2.77%) patient. Ascites and encephalopathy did not exacerbate in any of the patients. Hepatocellular carcinoma developed in two patients during the study period. 8 (22.2%) patients expired during the follow-up period. Kaplan Meir analysis showed that the median survival time was more than 69 months. Conclusion: BRTO may be a viable solution for prophylactic and therapeutic managing of fundal varices and ectopic variceal bleeding, especially when conventional treatments are unsuccessful or contraindicated.