Department of Medicine, Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, Virginia, USA.
Curr Opin Gastroenterol. 2023 May 1;39(3):140-145. doi: 10.1097/MOG.0000000000000915. Epub 2023 Mar 1.
Balloon-occluded retrograde transvenous obliteration (BRTO) is becoming a more commonly used procedure to manage various complications of liver disease. It is important to understand the technique of the procedure, the indications for its use, and also potential associated complications.
BRTO is superior to endoscopic cyanoacrylate injection and transjugular intrahepatic portosystemic shunt for bleeding gastric varices associated with a portosystemic shunt and should be considered a first line therapy in these patients. In addition, it has been shown to be useful in controlling ectopic variceal bleeding, improving portosystemic encephalopathy, and also in modulating blood flow in the post liver transplant setting. Modified versions of BRTO, plug assisted retrograde transvenous obliteration and coil assisted retrograde transvenous obliteration, have been developed to reduce procedure time and improve complication rates.
As the use of BRTO expands in clinical practice it will be important for gastroenterologists and hepatologists to better understand the procedure. There are still many research questions left to answer regarding the use of BRTO in specific situations and for specific patient populations.
球囊阻塞逆行经静脉闭塞术（BRTO）已成为一种治疗各种肝病相关并发症的常用方法。理解该技术的操作流程、适应证以及潜在相关并发症非常重要。
BRTO 在治疗与门腔分流相关的胃静脉曲张出血方面优于内镜下氰基丙烯酸酯注射和经颈静脉肝内门体分流术，对于此类患者，BRTO 应被视为一线治疗方法。此外，BRTO 还被证明可有效控制异位静脉曲张出血、改善门体系统脑病，以及调节肝移植后的血流。为了缩短操作时间、降低并发症发生率，改良版 BRTO（球囊辅助逆行经静脉闭塞术和线圈辅助逆行经静脉闭塞术）应运而生。
随着 BRTO 在临床实践中的应用不断扩大，胃肠病学家和肝病学家需要更好地理解这一技术。BRTO 在特定情况下以及特定患者人群中的应用仍存在许多尚未解答的研究问题。
