| Theme | Diagnosis and Treatment of Portal Hypertention | |
|---|---|---|
| Title | Prophylactic Treatment for Isolated Gastric Fundal Varices -- B-RTO, BES | |
| Publish Date | 2007/05 | |
| Author | Akio Matsumoto | Department of Internal Medicine, Kumiyama Minami Hospital |
| Author | Kengo Takimoto | Department of Gastroenterology, Takeda General Hospital |
| [ Summary ] | It has been reported that esophageal varices rarely bleed when the portal pressure gradient (PPG) is < 12 mmHg. Transjugular intrahepatic portosystemic shunting (TIPS) is considered to be a second-line treatment for patients with gastroesophageal varices that are unresponsive to pharmacologic and endoscopic treatment. However, bleeding from isolated gastric fundal varices can occur even when the PPG is < 12 mmHg. Several reports showed that TIPS only improved the mortality rate in patients with bleeding at a PPG ≥ 12 mmHg. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a new radiologic technique that was recently developed in Japan for the treatment of patients with isolated gastric fundal varices with a gastrorenal or a gastrophrenic shunt. B-RTO is similar to TIPS but is less invasive, and is technically easy for interventional radiologists to perform. In contrast, esophageal varices were likely to be worse after treatment with B-RTO because of elevations in portal pressure, which required treatment with endoscopic sclerotherapy. Partial splenic embolization can prevent the elevation of portal pressure after B-RTO. B-RTO is a recommended therapeutic option for the treatment of patients with isolated gastric fundal varices associated with a gastrorenal or gastrophrenic shunt, irrespective of the PPG or the shape or size of the varices. |
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