Clinical Gastroenterology Vol.27 No.2(2-2)

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 PPG≄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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