Balloon-occluded retrograde transvenous obliteration for duodenal varices: a retrospective observational study

To investigate the efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) for duodenal varices.

Twenty-two consecutive cases of BRTO for duodenal varices between January 2001 and September 2020 were retrospectively reviewed. Preoperative patient characteristics, anatomical features of duodenal varices, treatment outcomes and technical aspects of BRTO, long-term results (bleeding-free survival and recurrence-free survival), overall survival, and complications were evaluated.

Technical success was achieved in 77.3% (17/22) of cases. The technical success rate was 87.5% (14/16) in prophylactic cases, and 50.0% (3/6) in emergency cases. Clinical success was achieved in all 17 technically successful cases. After 6, 12, and 24 months of successful BRTO, bleeding-free survival remained 100% at all time points, recurrence-free survival was 100%, 92.3%, and 83.1% and overall survival was 86.7%, 86.7%, and 78.0%, respectively. Overall survival was significantly lower in ruptured cases than in non-ruptured cases (P = .0002). Within 3 months of BRTO, ascites worsened in 29.4% (5/17) of patients, and other gastrointestinal varices worsened in 25.0% (4/16) of patients. Post-BRTO portal vein thrombosis was detected within 1 week in 5.9% (1/17) cases.

BRTO appears to be a safe and effective primary prophylactic treatment option for duodenal varices.

This study provides evidence of the efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in treating duodenal varices. Since duodenal variceal rupture has the possibility of worsening patient prognosis, prophylactic BRTO might be performed to prevent rupture.