Internal Medicine, Hurley Medical Center, Flint, Michigan, USA.
Division of Gastroenterology & Hepatology, Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
BMJ Case Rep. 2021 Sep 6;14(9):e244405. doi: 10.1136/bcr-2021-244405.
Gastric and oesophageal variceal bleeding poses high morbidity and mortality in cirrhosis. Amongst all types, isolated gastric varices (IGV) carry the highest propensity to bleed. Successful outcomes combine endoscopic and interventional radiology approaches using ligation, coils, glue or sclerosants. Transjugular intrahepatic portosystemic shunt success is only seen in a subset of patients, while balloon-retrograde transvenous obliteration (BRTO) has demonstrated high efficacy in preventing rebleeding and morbidity in patients with a myriad of anatomies and shunts. The American Association for the Study of Liver disease guidelines do not favour any particular modality; however, recent trials and meta-analyses support BRTO as the first-line therapy. Despite promising results, BRTO adoption is limited by procedural time, patient length-of-stay and equipment compatibilities hindering scalability in academic and community settings. To address these concerns, we present a successfully treated case of IGV with a revised technique called accelerated BRTO.
胃食管静脉曲张出血在肝硬化患者中具有较高的发病率和死亡率。在所有类型中，孤立性胃静脉曲张（IGV）出血的风险最高。成功的治疗需要结合内镜和介入放射学方法，包括结扎、线圈、胶或硬化剂。经颈静脉肝内门体分流术（TIPS）仅适用于一部分患者，而球囊逆行静脉闭塞术（BRTO）在预防各种解剖和分流患者再出血和并发症方面显示出了很高的疗效。美国肝病研究协会指南并不支持任何特定的治疗方法；然而，最近的试验和荟萃分析支持 BRTO 作为一线治疗。尽管结果令人鼓舞，但 BRTO 的应用受到操作时间、患者住院时间和设备兼容性的限制，在学术和社区环境中的可扩展性受到阻碍。为了解决这些问题，我们提出了一个成功治疗孤立性胃静脉曲张的病例，采用了一种称为加速 BRTO 的改良技术。
