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Comparison of treatment outcomes between balloon‐occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis
Author(s) -
Lee Shin Jae,
Kim Seung Up,
Kim ManDeuk,
Kim Young Hwan,
Kim Gyoung Min,
Park Sung Il,
Won Jong Yun,
Lee Do Yun,
Lee KwangHun
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13729
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , cirrhosis , gastroenterology , gastric varices , hepatocellular carcinoma , hepatitis c , retrospective cohort study , model for end stage liver disease , hazard ratio , surgery , portal hypertension , confidence interval , liver transplantation , transplantation
Background and Aim Both balloon‐occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB. Methods A total of 142 patients undergoing BRTO ( n = 95) or TIPS ( n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review. Results Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause ( n = 63, 44.4%), followed by hepatitis B ( n = 60, 42.3%) and hepatitis C ( n = 7, 4.9%) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1%) patients. During the follow‐up period (mean, 28.2 months), 27 patients (19%) experienced re‐bleeding. Cumulative re‐bleeding rates after BRTO (8.6% at 1 year; 22.7% at 3 years) were significantly lower than those after TIPS (19.8% at 1 year; 48.2% at 3 years; P = 0.006, log‐rank test). In multivariate analysis, TIPS ( vs BRTO) was found independently predictive of re‐bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child–Pugh score (both P < 0.05). Although BRTO surpassed TIPS ( P = 0.026, log‐rank test) in terms of overall postprocedural survival, independent factors predictive of poor overall survival after hemostasis were concurrent HCC (HR = 3.106), high Child–Pugh score (HR = 1.886 per 1‐point increase), and postprocedural hepatic encephalopathy (HR = 3.014; all P < 0.05). Conclusion Balloon‐occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re‐bleeding.