Mukund Amar, Rangarh Pulkit, Shasthry Saggere Muralikrishna, Patidar Yashwant, Sarin Shiv Kumar
Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
J Clin Exp Hepatol. 2020 Sep-Oct;10(5):421-428. doi: 10.1016/j.jceh.2020.04.010. Epub 2020 Apr 18.
To analyze the outcomes of balloon occluded retrograde transvenous obliteration (BRTO) as salvage therapy in cirrhotic patients with gastric variceal bleed (GVB) after failed endotherapy or very early rebleeds. We assessed for technical/clinical success of BRTO and transplantation-free survival.
Patients with GVB who underwent BRTO as salvage therapy (between 2011 and 2017) were analyzed. Rebleed rate, Child Pugh score (CTP), Model for end-stage liver disease (MELD) values were calculated at 1,6,12, and 24 months follow-up.
Fifty-two patients who underwent BRTO as salvage therapy were assessed for rebleed rate and transplantation-free survival. Technical success was 100% with rebleed rate being 1.9% (n = 1) and clinical success rate of 92.3% (n = 48) at 12-months follow-up and transplantation-free one-year survival of 90.4% (n = 47). Five patients (9.6%) failed to achieve one-year transplantation-free survival. Four patients died within 30 days; one rebleed, 3 (all Child C) progressive liver and multiorgan failure and one required liver transplantation (day 88) after BRTO. Thus, a total of 4 of 9 (44.4%) Child C patients failed to achieve one-year transplantation-free survival. Improvement in liver functions was noted in the rest with improved CTP, MELD scores, and albumin levels in the 12-month follow-up. Six of 52 (11.5%) developed new onset medically manageable ascites, whereas 7 of 52 (13.5%) had progression of esophageal varices at 12-months follow-up requiring prophylactic band ligation in follow-up.
Salvage BRTO is a safe and effective procedure for patients with acute GVB with failure to control bleed with endotherapy or very early rebleed after endotherapy. Salvage BRTO has good short/long-term outcomes with lower rebleed, higher survival, and improved liver disease severity.
分析球囊闭塞逆行静脉栓塞术（BRTO）作为挽救性治疗手段，用于治疗内镜治疗失败或极早期再出血的肝硬化胃静脉曲张出血（GVB）患者的疗效。我们评估了BRTO的技术/临床成功率以及无移植生存率。
对2011年至2017年间接受BRTO作为挽救性治疗的GVB患者进行分析。在1、6、12和24个月随访时计算再出血率、Child-Pugh评分（CTP）、终末期肝病模型（MELD）值。
对52例接受BRTO作为挽救性治疗的患者评估了再出血率和无移植生存率。技术成功率为100%，12个月随访时再出血率为1.9%（n = 1），临床成功率为92.3%（n = 48），无移植一年生存率为90.4%（n = 47）。5例患者（9.6%）未能实现一年无移植生存。4例患者在30天内死亡；1例再出血，3例（均为Child C级）出现进行性肝功能衰竭和多器官功能衰竭，1例在BRTO后88天需要进行肝移植。因此，9例Child C级患者中有4例（44.4%）未能实现一年无移植生存。其余患者肝功能有所改善，12个月随访时CTP、MELD评分及白蛋白水平均有所改善。52例患者中有6例（11.5%）出现新发可药物控制的腹水，52例患者中有7例（13.5%）在12个月随访时食管静脉曲张进展，后续需要进行预防性套扎。
挽救性BRTO对于急性GVB且内镜治疗无法控制出血或内镜治疗后极早期再出血的患者是一种安全有效的治疗方法。挽救性BRTO具有良好的短期和长期疗效，再出血率较低，生存率较高，且肝病严重程度有所改善。
