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Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis

 Shin Jae Lee  ;  Seung Up Kim  ;  Man‐Deuk Kim  ;  Young Hwan Kim  ;  Gyoung Min Kim  ;  Sung Il Park  ;  Jong Yun Won  ;  Do Yun Lee  ;  Kwang‐Hun Lee 
 Journal of Gastroenterology and Hepatology, Vol.32(8) : 1487-1494, 2017 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Aged ; Balloon Occlusion/methods* ; Esophageal and Gastric Varices/complications* ; Female ; Gastrointestinal Hemorrhage/etiology* ; Gastrointestinal Hemorrhage/therapy* ; Hemostasis, Surgical/methods* ; Hepatitis B/complications ; Hepatitis C/complications ; Humans ; Liver Cirrhosis, Alcoholic/complications ; Male ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic/methods* ; Retrospective Studies ; Treatment Outcome
balloon-occluded retrograde transvenous obliteration ; gastric variceal bleeding ; outcome ; overall survival ; re-bleeding ; transjugular intrahepatic portosystemic shunt
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.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Gyoung Min(김경민) ORCID logo https://orcid.org/0000-0001-6768-4396
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Sung Il(박성일)
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Lee, Kwang Hun(이광훈)
Lee, Do Yun(이도연)
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