Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China.
Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China.
Arab J Gastroenterol. 2023 Nov;24(4):218-222. doi: 10.1016/j.ajg.2023.07.004. Epub 2023 Sep 9.
Balloon-occluded retrograde transvenous obliteration-assisted endoscopic cyanoacrylate injection (E-BRTO) temporarily treats gastric fundic varices draining through gastrorenal shunts (GRS) occluding the GRS with a balloon, then endoscopically injecting cyanoacrylate. We retrospectively examined the safety, feasibility, and efficacy of E-BRTO.
We enrolled 85 patients with hepatic cirrhosis plus gastric fundic varices with GRS; 34 underwent E-BRTO. The 51 patients who refused all secondary prophylactic treatments served as controls.
Finally, 33 of the 34 patients underwent successful E-BRTO without major adverse events. Gastric varices were eradicated from all 33 patients in the E-BRTO group; the average follow-up time was 161.0 (74.0) weeks (mean [SD]). Four end-point events (12%) were recorded during the follow-up period. In the control group, 33 patients (65%) suffered repeat variceal bleeding, resulting in seven deaths. The cumulative rebleeding rates of the E-BRTO group on the 6th, 24th, 48th, 96th, 144th, 192nd, 240th, and 288th week were 0%, 3%, 9%, 9%, 13%, 13%, 13%, and 13%, while the cumulative rebleeding rates of the control group in the same period were 10%, 20%, 35%, 46%, 55%, 65%, 76%, and 76%.
E-BRTO was safe, feasible, and well tolerated by patients with hepatic cirrhosis plus gastric fundic varices with GRS. Over the long-term follow-up period, the E-BRTO group demonstrated a lower rate of repeat bleeding than the control group.
球囊阻塞逆行经静脉闭塞辅助内镜氰基丙烯酸酯注射（E-BRTO）通过球囊暂时治疗通过胃肾分流（GRS）引流的胃底静脉曲张，然后在内镜下注射氰基丙烯酸酯。我们回顾性检查了 E-BRTO 的安全性、可行性和疗效。
我们纳入了 85 例伴有 GRS 的肝硬化合并胃底静脉曲张患者；其中 34 例行 E-BRTO。51 例拒绝所有二级预防治疗的患者作为对照组。
最终，34 例患者中有 33 例成功进行了 E-BRTO，无重大不良事件。E-BRTO 组 33 例患者的胃静脉曲张均被根除；平均随访时间为 161.0（74.0）周（均值[标准差]）。在随访期间记录了 4 个终点事件（12%）。对照组中，33 例患者（65%）再次出现静脉曲张出血，导致 7 例死亡。E-BRTO 组在第 6、24、48、96、144、192、240 和 288 周的累积再出血率分别为 0%、3%、9%、9%、13%、13%、13%和 13%，而对照组同期的累积再出血率分别为 10%、20%、35%、46%、55%、65%、76%和 76%。
E-BRTO 对伴有 GRS 的肝硬化合并胃底静脉曲张患者是安全、可行且耐受良好的。在长期随访期间，E-BRTO 组的再出血率低于对照组。
