| Theme | Treatment for Portal Hypertension : Update | |
|---|---|---|
| Title | Management of Gastric Varices with Balloon-occluded Retrograde Transvenous Obliteration (B-RTO) | |
| Publish Date | 2012/02 | |
| Author | Akio Matsumoto | Department of Internal Medicine, Kumiyama Minami 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 which are unresponsive to pharmacologic or endoscopic treatment. However, bleeding from gastric fundal varices (FV) can occur even when the PPG is < 12 mmHg. Several reports have shown that TIPS only improved mortality rates in patients with bleeding at PPGā„12 mmHg levels. Accordingly, decompressive procedures such as TIPS do not seem to provide much benefit for patients with FV who have major shunts and low PPG levels. B-RTO is similar to TIPS but less invasive, and is technically easy for interventional radiologists to perform. B-RTO is a recommended therapeutic option for treatment of patients with FV associated with splenorenal shunts, irrespective of PPG levels. |
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