Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices

  • Kim, Seung Kwon (Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine) ;
  • Lee, Kristen A. (Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine) ;
  • Sauk, Steven (Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine) ;
  • Korenblat, Kevin (Division of Gastroenterology, Department of Internal Medicine, Washington University St. Louis School of Medicine)
  • Received : 2016.06.23
  • Accepted : 2016.09.27
  • Published : 2017.04.01
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Abstract

Objective: Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. Materials and Methods: We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRTO. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups. Results: There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months. Conclusion: BRTO is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy.

Keywords

References

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