Division of Interventional Radiology, Department of Radiology, University of California at Los Angeles Medical Center, David Geffen School of Medicine at University of California, Los Angeles.
Division of Liver and Pancreas Transplantation, Department of Surgery, University of California at Los Angeles Medical Center, David Geffen School of Medicine at University of California, Los Angeles.
JAMA Surg. 2019 Jun 1;154(6):540-548. doi: 10.1001/jamasurg.2019.0407.
Varices are one of the main clinical manifestations of cirrhosis and portal hypertension. Gastric varices are less common than esophageal varices but are often associated with poorer prognosis, mainly because of their higher propensity to bleed.
Currently, treatments used to control and manage gastric variceal bleeding include β-blockers, endoscopic injection sclerotherapy, endoscopic variceal ligation, endoscopic variceal obturation, shunt surgery, transjugular intrahepatic portosystemic shunts, balloon-occluded retrograde transvenous obliteration (BRTO), and modified BRTO. In the past few decades, Western (United States and Europe) interventional radiologists have preferred transjugular intrahepatic portosystemic shunts that aim to decompress the liver and reduce portal pressure. Conversely, Eastern radiologists (Japan and South Korea) have preferred BRTO that directly targets the gastric varices. Over the past 20 years, BRTO has evolved and procedure-related risks have decreased. Owing to its safety and efficiency in treating gastric varices, BRTO is now starting to gain popularity among Western interventional radiologists. In this review, we present a comprehensive literature review of current and emerging management options, including BRTO and modified BRTO, for the treatment of gastric varices in the setting of cirrhosis and portal hypertension.
Balloon-occluded retrograde transvenous obliteration has emerged as a safe and effective alternative treatment option for gastric variceal hemorrhage. A proper training, evidence-based consensus and guideline, thorough preprocedural and postprocedural evaluation, and a multidisciplinary team approach with BRTO and modified BRTO are strongly recommended to ensure best patient care.
静脉曲张是肝硬化和门静脉高压的主要临床特征之一。胃静脉曲张比食管静脉曲张少见，但往往与预后较差相关，主要是因为它们出血的倾向更高。
目前，用于控制和管理胃静脉曲张出血的治疗方法包括β受体阻滞剂、内镜注射硬化疗法、内镜静脉曲张结扎术、内镜静脉曲张闭塞术、分流手术、经颈静脉肝内门体分流术、经颈静脉肝内门体分流术（TIPS）、球囊阻塞逆行经静脉闭塞术（BRTO）和改良 BRTO。在过去的几十年中，西方（美国和欧洲）介入放射学家更喜欢 TIPS，旨在减轻肝脏压力并降低门静脉压力。相反，东方放射学家（日本和韩国）更喜欢直接针对胃静脉曲张的 BRTO。在过去的 20 年中，BRTO 已经发展，相关程序的风险已经降低。由于其在治疗胃静脉曲张方面的安全性和有效性，BRTO 现在开始在西方介入放射学家中流行起来。在这篇综述中，我们对当前和新兴的治疗选择进行了全面的文献回顾，包括 BRTO 和改良 BRTO，用于治疗肝硬化和门静脉高压症中的胃静脉曲张。
球囊阻塞逆行经静脉闭塞术已成为治疗胃静脉曲张出血的一种安全有效的替代治疗选择。强烈建议进行适当的培训、基于循证的共识和指南、彻底的术前和术后评估以及多学科团队合作，以确保最佳的患者护理。
