Open AccessBalloon‐occluded retrograde transvenous obliteration as a procedure to improve liver function in patients with decompensated cirrhosis
Author(s) -
Nakazawa Manabu,
Imai Yukinori,
Uchiya Hiroshi,
Ando Satsuki,
Sugawara Kayoko,
Nakayama Nobuaki,
Tomiya Tomoaki,
Mochida Satoshi
Publication year - 2017
Publication title -
jgh open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.546
H-Index - 8
ISSN - 2397-9070
DOI - 10.1002/jgh3.12020
Subject(s) - medicine , liver function , cirrhosis , portal hypertension , balloon , gastric varices , ascites , catheter , portosystemic shunt , liver function tests , balloon catheter , surgery , varices , blood flow , prothrombin time , gastroenterology , radiology
Aim Portosystemic shunts aggravate liver function by decreasing portal blood flow. The usefulness of balloon‐occluded retrograde transvenous obliteration (B‐RTO), a standardized therapeutic procedure for gastric fundal varices (GFV), for the improvement of liver function was evaluated in cirrhotic patients with or without varices. Methods The subjects were 161 patients with portosystemic shunts. A balloon catheter was inserted into the shunts, followed by the injection of 5% ethanolamine oleate through the catheter under balloon inflation. The balloon was kept inflated for 6 to 48 h. Results B‐RTO was performed as a therapy for GFV in 112 patients and for the improvement of liver function in 49 patients. The targets were splenorenal shunts in 104 patients (93.6%) in the former group and 33 patients (67.3%) in the latter group, and the procedures were successfully completed in 109 (97.3%) and 39 (79.6%) patients, respectively. In both groups, the serum albumin levels were increased and the serum ammonia levels were decreased at more than 1 month after the procedures, compared with the baseline levels, whereas significant improvements in the Child–Pugh scores and prothrombin times were only seen in the latter group. In these patients, the portal blood flows evaluated using Doppler ultrasound were increased at 1 week after the procedures, compared with the baseline levels. Conclusions B‐RTO is a useful therapeutic procedure for improving liver function even in patients without GFV by increasing the portal venous flow with successfully targeted, uncommon portosystemic shunts.