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Primary prophylaxis of gastric variceal bleeding: endoscopic obturation, radiologic intervention, or observation?

Jung Wan Choe1, Hyung Joon Yim2, Seung Hwa Lee3

  • 1Department of Internal Medicine, Korea University College of Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, 15355, Korea.

Hepatology International
|March 11, 2021
PubMed

Insights

Endoscopic variceal obturation (EVO) and balloon-occluded retrograde transvenous obliteration (BRTO) effectively prevent gastric varices bleeding. BRTO shows superior eradication rates compared to EVO.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Interventional Endoscopy

Background:

  • Gastric varices (GV) pose a bleeding risk in liver cirrhosis patients.
  • Effective primary prophylaxis for gastric varices remains elusive.

Purpose of the Study:

  • To evaluate the efficacy of endoscopic variceal obturation (EVO) and balloon-occluded retrograde transvenous obliteration (BRTO) in preventing gastric varices bleeding.
  • To compare the complete eradication rates of GV between EVO and BRTO.

Main Methods:

  • Retrospective analysis of liver cirrhosis patients with GV.
  • Comparison of prophylactic treatments: EVO, BRTO, and clinical observation.
  • Endpoints: GV bleeding rate and complete eradication rate.

Main Results:

  • EVO and BRTO significantly reduced GV bleeding compared to observation (p<0.05).
  • BRTO demonstrated a higher complete eradication rate (75.6%) than EVO (45.8%) (p=0.003).
  • Complete eradication of GV was the sole predictor of reduced bleeding risk.

Conclusions:

  • EVO and BRTO are safe and effective prophylactic treatments for gastric varices.
  • BRTO is more effective than EVO for complete eradication of gastric varices.
Abstract

Keywords:
Balloon-occluded retrograde transvenous obliterationEndoscopyGastric varixInterventionLiver cirrhosisPreventionProphylaxisVariceal bleedingVariceal hemorrhageVariceal obliteration

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