Almohannadi Muneera, Omar Ahmed, Barah Ali, Joudeh Anwar I, Badi Ahmed M, Ali Yousra, Yahia Yousef, Singh Rajvir, Varughese Betsy, Yakoob Rafie
Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, QAT.
Radiology, Hamad Medical Corporation, Doha, QAT.
Cureus. 2025 May 8;17(5):e83726. doi: 10.7759/cureus.83726. eCollection 2025 May.
This study aims to assess the short- and long-term outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) in managing gastric varices (GV).
We conducted a retrospective chart review of all patients who underwent BRTO for actively bleeding or at high-hemorrhagic-risk GV secondary to liver cirrhosis at our facility from January 2007 to December 2019. Descriptive and analytical statistics were used to evaluate short- and long-term postprocedural outcomes. Univariate and multivariate analyses were used to identify significant factors associated with mortality. Survival was assessed using the Kaplan-Meier method. A p-value of <0.05 was considered statistically significant.
A total of 35 patients (mean age: 53.3 ± 9.9 years) were included, with the majority being men (N = 29, 82.9%). Most patients had Child-Pugh classification A (N = 14, 40%) or B (N = 13, 37.1%). Twenty-two patients (62.9%) underwent BRTO emergently, and 13 (37.1%) underwent the procedure prophylactically. Collateral embolization and hemostasis were achieved in all but one patient. Gastric variceal recurrence occurred in five patients (14%), and esophageal varices (EV) worsened in three (9%). During a mean follow-up of 96.2 ± 9 months, seven patients (20%) experienced variceal bleeding episodes, all managed endoscopically. The estimated post-BRTO survival rates at 1, 3, 5, and 10 years were 82.1%, 82.1%, 76.6%, and 68.1%, respectively. Preprocedural Child-Pugh classification A or B and total bilirubin levels < 3.5 mg/dL were associated with better survival rates.
BRTO is a safe and effective treatment for both emergent bleeding control and prophylactic management of high-hemorrhagic-risk GV.
本研究旨在评估球囊闭塞逆行静脉栓塞术（BRTO）治疗胃静脉曲张（GV）的短期和长期疗效。
我们对2007年1月至2019年12月在我院因肝硬化继发活动性出血或高出血风险胃静脉曲张而接受BRTO治疗的所有患者进行了回顾性病历审查。采用描述性和分析性统计方法评估术后短期和长期疗效。采用单因素和多因素分析确定与死亡率相关的显著因素。使用Kaplan-Meier方法评估生存率。p值<0.05被认为具有统计学意义。
共纳入35例患者（平均年龄：53.3±9.9岁），其中男性居多（N = 29，82.9%）。大多数患者的Child-Pugh分级为A（N = 14，40%）或B（N = 13，37.1%）。22例患者（62.9%）急诊接受BRTO治疗，13例（37.1%）接受预防性治疗。除1例患者外，其余患者均实现了侧支栓塞和止血。5例患者（14%）出现胃静脉曲张复发，3例患者（9%）食管静脉曲张（EV）恶化。在平均96.2±9个月的随访期间，7例患者（20%）发生静脉曲张出血事件，均通过内镜治疗。BRTO术后1年、3年、5年和10年的估计生存率分别为82.1%、82.1%、76.6%和68.1%。术前Child-Pugh分级为A或B以及总胆红素水平<3.5 mg/dL与更好的生存率相关。
BRTO是一种安全有效的治疗方法，可用于紧急控制出血和预防性治疗高出血风险的胃静脉曲张。
