Department of Gastroenterology, University of New Mexico, Albuquerque, NM.
Departments of Gastroenterology.
J Clin Gastroenterol. 2020 Aug;54(7):655-660. doi: 10.1097/MCG.0000000000001275.
Although gastric variceal (GV) bleeding is less common than esophageal variceal bleeding, the severity of GV bleeding is often greater with higher morbidity and mortality rates. Minimally invasive endovascular treatments such as balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) have been used for the management of GVs with varying results, and individual and institutional differences exist in the use of BRTO and TIPS. We performed a systematic review and meta-analysis to compare the feasibility, efficacy, and safety of BRTO and TIPS for the treatment of GVs because of portal hypertension.
Searches of PubMed, EMBASE, Google Scholar, and Cochrane Library databases were performed from inception through March 2019. Summary odds ratio (OR) with 95% confidence intervals (CI) was estimated for technical success, hemostasis rate, postprocedural complications, rebleeding rate, incidence of hepatic encephalopathy, and mortality rate at 1 year utilizing a random-effects model.
Seven studies with a total of 676 patients (BRTO: 462 and TIPS: 214) were included. There was no difference in pooled technical success rate (OR, 0.87; 95% CI, 0.28-2.73; P=0.81), hemostasis rate (OR, 2.74; 95% CI, 0.61-12.26; P=0.19), and postoperative procedure-related complications (OR, 1.95; 95% CI, 0.44-8.72; P=0.38). However, treatment with BRTO was associated with lower rates of postoperative rebleeding (OR, 0.30; 95% CI, 0.18-0.48; P<0.00001), postoperative encephalopathy (OR, 0.06; 95% CI, 0.02-0.15; P < 0.00001), and mortality at 1 year (OR, 0.43; 95% CI, 0.21-0.87; P=0.02).
BRTO was associated with lower rates of rebleeding, postprocedure hepatic encephalopathy, and mortality at 1 year. BRTO should be considered first-line modality for the treatment of GVs because of portal hypertension.
尽管胃静脉曲张（GV）出血不如食管静脉曲张出血常见，但 GV 出血的严重程度通常更高，发病率和死亡率也更高。球囊闭塞逆行经静脉闭塞（BRTO）和经颈静脉肝内门体分流术（TIPS）等微创血管内治疗已用于治疗 GV，其结果各不相同，BRTO 和 TIPS 的使用存在个体和机构差异。我们进行了系统评价和荟萃分析，以比较 BRTO 和 TIPS 治疗门静脉高压引起的 GV 的可行性、疗效和安全性。
从开始到 2019 年 3 月，对 PubMed、EMBASE、Google Scholar 和 Cochrane 图书馆数据库进行了检索。使用随机效应模型估算技术成功率、止血率、术后并发症、再出血率、肝性脑病发生率和 1 年死亡率的汇总比值比（OR）及其 95%置信区间（CI）。
纳入了 7 项研究，共 676 例患者（BRTO：462 例，TIPS：214 例）。BRTO 和 TIPS 的技术成功率（OR，0.87；95%CI，0.28-2.73；P=0.81）、止血率（OR，2.74；95%CI，0.61-12.26；P=0.19）和术后与程序相关的并发症发生率（OR，1.95；95%CI，0.44-8.72；P=0.38）没有差异。然而，BRTO 治疗与较低的术后再出血率（OR，0.30；95%CI，0.18-0.48；P<0.00001）、术后脑病（OR，0.06；95%CI，0.02-0.15；P < 0.00001）和 1 年死亡率（OR，0.43；95%CI，0.21-0.87；P=0.02）相关。
BRTO 与较低的再出血率、术后肝性脑病和 1 年死亡率相关。BRTO 应作为治疗门静脉高压引起的 GV 的一线治疗方法。
