Howarth Nisha, Sachar Yashasavi, Little Derek Hw, Peck David, Mujoomdar Amol, Cool Derek W, Hocking David, Teriaky Anouar, Qumosani Karim, Khan Qasim, Tang Ephraim, Skaro Anton, Arab Juan Pablo, Brahmania Mayur
Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada.
Department of Medical Imaging, Division of Interventional Radiology, Western University, London, ON, Canada.
Can Liver J. 2025 Feb 25;8(1):79-89. doi: 10.3138/canlivj-2024-0012. eCollection 2025 Feb.
Retrograde transvenous obliteration is an endovascular interventional radiology procedure demonstrating safety and efficacy for secondary prophylaxis in high-risk gastric varices. However, its efficacy as primary prophylaxis is uncertain. We conducted a systematic review and case series to evaluate the utility of this technique.
A literature search utilized EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. Inclusion criteria involved single technique obliteration, known varices, and exclusively primary prophylaxis. The primary outcome was gastric variceal bleeding, with secondary outcomes of technical success, variceal eradication, adverse events, and mortality. A retrospective case series of nine patients who underwent primary prophylaxis at our North American centre was also conducted.
Of the 842 articles retrieved, 69 were eligible for full-text review, with the 9 studies included in the final analysis involving balloon-occluded, but not plug-assisted or coil-assisted, techniques. Only 2/9 studies involved comparator groups, with a single prospective non-randomized trial, and there was a high risk of bias in 8/9 studies. The technical success rate of the balloon-occluded obliteration technique ranged from 82% to 100%, and the variceal eradication rate ranged from 88% to 100%. In comparative studies, patients had decreased variceal bleeding and bleeding-related mortality compared with control cohorts. Our case series demonstrated a 78% survival rate with no variceal bleeding. Post-procedure ascites and worsening esophageal varices ranged from 0-55% to 11-80%, respectively.
This review summarizes evidence regarding the efficacy of retrograde transvenous obliteration, with available studies demonstrating a high success rate in eradicating varices and preventing bleeding-associated mortality, albeit with concerns of overall quality of existing literature.
逆行经静脉闭塞术是一种血管内介入放射学手术，已证明其在高危胃静脉曲张二级预防中具有安全性和有效性。然而，其作为一级预防的效果尚不确定。我们进行了一项系统评价和病例系列研究，以评估该技术的实用性。
利用EMBASE、MEDLINE和Cochrane对照试验中央注册库进行文献检索。纳入标准包括单一技术闭塞、已知静脉曲张且仅为一级预防。主要结局是胃静脉曲张出血，次要结局包括技术成功、静脉曲张根除、不良事件和死亡率。我们还对北美中心接受一级预防的9例患者进行了回顾性病例系列研究。
在检索到的842篇文章中，69篇符合全文审查标准，最终分析纳入的9项研究均涉及球囊闭塞技术，但不包括栓塞辅助或弹簧圈辅助技术。只有2/9的研究涉及比较组，其中一项为前瞻性非随机试验，且8/9的研究存在高偏倚风险。球囊闭塞闭塞技术的技术成功率为82%至100%，静脉曲张根除率为88%至100%。在比较研究中，与对照组相比，患者的静脉曲张出血和出血相关死亡率有所降低。我们的病例系列显示生存率为78%，无静脉曲张出血。术后腹水和食管静脉曲张恶化的发生率分别为0-55%和11-80%。
本综述总结了关于逆行经静脉闭塞术疗效的证据，现有研究表明该技术在根除静脉曲张和预防出血相关死亡率方面成功率较高，尽管现有文献的整体质量令人担忧。
