Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
Eur J Gastroenterol Hepatol. 2020 May;32(5):656-662. doi: 10.1097/MEG.0000000000001705.
In this study, we propose a modified balloon-occluded retrograde transvenous obliteration (BRTO) strategy - balloon-assisted antegrade transvenous obliteration (BAATO), and explore the feasibility, efficacy and safety of BAATO combined with transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cardiofundal varices (GOV2 or IGV1) hemorrhage.
In this retrospective cohort study, 15 patients with cardiofundal varices hemorrhage who received BAATO combined with TIPS procedures, from August 2017 to September 2019 in our center, were enrolled. They consisted of seven patients with GOV2 and eight patients with IGV1. The clinical efficacy and safety of BAATO + TIPS procedures were assessed by comparing the clinical symptoms, laboratory and imaging examinations before and after treatment.
The technical success rate of BAATO + TIPS procedure was 100%. After the procedure, clinical symptoms were improved and complete regression of gastric varices (GVs) was observed in all patients, besides, the control efficiency of ascites and PVT which were 77.8 and 87.5%, respectively. No patient died or had a rebleeding during the follow up, but grade II hepatic encephalopathy (HE) occurred in two patients (13.3%) and shunt dysfunction was discovered in one patient (6.7%).
For the treatment of GVs, the new technique BAATO is feasible, safe and effective, and it may be a more convenient and economical method than conventional BRTO. In addition, the combination of BAATO and TIPS may play a positive role in achieving hemostasis and improving the complications of portal hypertension such as ascites and PVT.
本研究提出了一种改良的球囊阻塞逆行经静脉闭塞（BRTO）策略-球囊辅助顺行经静脉闭塞（BAATO），并探讨了 BAATO 联合经颈静脉肝内门体分流术（TIPS）治疗胃心静脉曲张（GOV2 或 IGV1）出血的可行性、疗效和安全性。
本回顾性队列研究纳入了 2017 年 8 月至 2019 年 9 月在我院接受 BAATO 联合 TIPS 治疗的 15 例胃心静脉曲张出血患者，其中包括 7 例 GOV2 患者和 8 例 IGV1 患者。通过比较治疗前后的临床症状、实验室和影像学检查，评估 BAATO+TIPS 治疗的临床疗效和安全性。
BAATO+TIPS 治疗的技术成功率为 100%。治疗后，所有患者的临床症状均得到改善，胃静脉曲张（GVs）完全消退，腹水和 PVT 的控制效率分别为 77.8%和 87.5%。随访期间无患者死亡或再出血，但 2 例（13.3%）患者出现 II 级肝性脑病（HE），1 例（6.7%）患者出现分流功能障碍。
对于 GVs 的治疗，新技术 BAATO 是可行、安全且有效的，且可能比传统的 BRTO 更为便捷、经济。此外，BAATO 联合 TIPS 可能在实现止血和改善腹水和 PVT 等门脉高压并发症方面发挥积极作用。
