Balloon Retrograde Transvenous Obliteration Versus Endoscopic Cyanoacrylate in Bleeding Gastric Varices: Comparison of Rebleeding and Mortality with Extended Follow-up.
Balloon Retrograde Transvenous Obliteration Versus Endoscopic Cyanoacrylate in Bleeding Gastric Varices: Comparison of Rebleeding and Mortality with Extended Follow-up.
- 2019
Available online through MWHC library: 2002 - 2006, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: BRTO is associated with a lower rate of rebleeding but no change in mortality. Copyright (c) 2018 SIR. Published by Elsevier Inc. All rights reserved. MATERIALS AND METHODS: A retrospective cohort comparison was conducted of 90 EC patients and 71 BRTO patients from 1997 through 2015 with portal hypertension who presented due to endoscopically confirmed bleeding cardiofundal gastric varices. Patients underwent either endoscopic intra-varix injection of 4-carbon-n-butyl-2-cyanoacrylate or sclerosis with sodium tetradecyl sulfate with balloon occlusion for primary variceal treatment. PURPOSE: To assess short- and long-term mortality and rebleeding with endoscopic cyanoacrylate (EC) versus balloon-occluded retrograde transvenous obliteration (BRTO). RESULTS: Seventy-one BRTO patients and 90 EC patients, of whom 89% had cirrhosis and 35% were women, were included, with a respective average Model for End-Stage Liver Disease (MELD) score of 13.4 and 14.4, respectively. Mortality at 6 weeks was 14.4% for EC patients and 13.1% for BRTO patients (Kaplan-Meier/Wilcoxon, P = .85). No long-term mortality difference was observed (Cox hazard ratio [HR] = 0.89, P = .64). Also, 5.1% of EC patients and 3.5% of BRTO patients (Kaplan-Meier/Wilcoxon, P = .62) rebled at 6 weeks, but at 1 year, 22.0% of EC patients and 3.5% of BRTO patients had rebled (Kaplan-Meier/Wilcoxon, P < .01). Lower rates of long-term rebleeding were found with BRTO (Cox HR = 0.25, P = .03). No difference was seen in the rate of new portal hypertensive complications (Cox HR = 1.21, P = .464). However, 16/71 patients who underwent BRTO had simultaneous transjugular intrahepatic portosystemic shunt. Age, sex, MELD score, and presence of cirrhosis were the primary predictors of mortality. One death in the EC group and 5 deaths in the BRTO group were deemed to be procedurally related (chi-square, P = .088).
English
1051-0443
10.1016/j.jvir.2018.12.008 [doi] S1051-0443(18)31777-9 [pii]
*Balloon Occlusion
*Enbucrilate/ad [Administration & Dosage]
*Esophageal and Gastric Varices/th [Therapy]
*Gastrointestinal Hemorrhage/th [Therapy]
*Hemostasis, Endoscopic/mt [Methods]
Adult
Aged
Balloon Occlusion/ae [Adverse Effects]
Balloon Occlusion/mo [Mortality]
Enbucrilate/ae [Adverse Effects]
Esophageal and Gastric Varices/di [Diagnosis]
Esophageal and Gastric Varices/et [Etiology]
Esophageal and Gastric Varices/mo [Mortality]
Female
Follow-Up Studies
Gastrointestinal Hemorrhage/di [Diagnosis]
Gastrointestinal Hemorrhage/et [Etiology]
Gastrointestinal Hemorrhage/mo [Mortality]
Hemostasis, Endoscopic/ae [Adverse Effects]
Hemostasis, Endoscopic/mo [Mortality]
Humans
Hypertension, Portal/co [Complications]
Hypertension, Portal/mo [Mortality]
Male
Middle Aged
Recurrence
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
MedStar Washington Hospital Center
Radiology
Journal Article
Available online through MWHC library: 2002 - 2006, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: BRTO is associated with a lower rate of rebleeding but no change in mortality. Copyright (c) 2018 SIR. Published by Elsevier Inc. All rights reserved. MATERIALS AND METHODS: A retrospective cohort comparison was conducted of 90 EC patients and 71 BRTO patients from 1997 through 2015 with portal hypertension who presented due to endoscopically confirmed bleeding cardiofundal gastric varices. Patients underwent either endoscopic intra-varix injection of 4-carbon-n-butyl-2-cyanoacrylate or sclerosis with sodium tetradecyl sulfate with balloon occlusion for primary variceal treatment. PURPOSE: To assess short- and long-term mortality and rebleeding with endoscopic cyanoacrylate (EC) versus balloon-occluded retrograde transvenous obliteration (BRTO). RESULTS: Seventy-one BRTO patients and 90 EC patients, of whom 89% had cirrhosis and 35% were women, were included, with a respective average Model for End-Stage Liver Disease (MELD) score of 13.4 and 14.4, respectively. Mortality at 6 weeks was 14.4% for EC patients and 13.1% for BRTO patients (Kaplan-Meier/Wilcoxon, P = .85). No long-term mortality difference was observed (Cox hazard ratio [HR] = 0.89, P = .64). Also, 5.1% of EC patients and 3.5% of BRTO patients (Kaplan-Meier/Wilcoxon, P = .62) rebled at 6 weeks, but at 1 year, 22.0% of EC patients and 3.5% of BRTO patients had rebled (Kaplan-Meier/Wilcoxon, P < .01). Lower rates of long-term rebleeding were found with BRTO (Cox HR = 0.25, P = .03). No difference was seen in the rate of new portal hypertensive complications (Cox HR = 1.21, P = .464). However, 16/71 patients who underwent BRTO had simultaneous transjugular intrahepatic portosystemic shunt. Age, sex, MELD score, and presence of cirrhosis were the primary predictors of mortality. One death in the EC group and 5 deaths in the BRTO group were deemed to be procedurally related (chi-square, P = .088).
English
1051-0443
10.1016/j.jvir.2018.12.008 [doi] S1051-0443(18)31777-9 [pii]
*Balloon Occlusion
*Enbucrilate/ad [Administration & Dosage]
*Esophageal and Gastric Varices/th [Therapy]
*Gastrointestinal Hemorrhage/th [Therapy]
*Hemostasis, Endoscopic/mt [Methods]
Adult
Aged
Balloon Occlusion/ae [Adverse Effects]
Balloon Occlusion/mo [Mortality]
Enbucrilate/ae [Adverse Effects]
Esophageal and Gastric Varices/di [Diagnosis]
Esophageal and Gastric Varices/et [Etiology]
Esophageal and Gastric Varices/mo [Mortality]
Female
Follow-Up Studies
Gastrointestinal Hemorrhage/di [Diagnosis]
Gastrointestinal Hemorrhage/et [Etiology]
Gastrointestinal Hemorrhage/mo [Mortality]
Hemostasis, Endoscopic/ae [Adverse Effects]
Hemostasis, Endoscopic/mo [Mortality]
Humans
Hypertension, Portal/co [Complications]
Hypertension, Portal/mo [Mortality]
Male
Middle Aged
Recurrence
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
MedStar Washington Hospital Center
Radiology
Journal Article