Portal response related to shunt occlusion by balloon-occluded retrograde transvenous obliteration may determine the prognosis of cirrhosis

• Published in: Hepatology research 2016-12, Vol.46 (13), p.1321-1329
• Main Authors: Kobayashi, Kazufumi, Maruyama, Hitoshi, Kiyono, Soichiro, Sekimoto, Tadashi, Kondo, Takayuki, Shimada, Taro, Takahashi, Masanori, Okugawa, Hidehiro, Yokosuka, Osamu
• Format: Article
• Language: English
• Subjects: B-RTO; cirrhosis; gastric varices; portal hypertension
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.12690

Aim To determine the prognostic effect of portal hemodynamic responses after balloon‐occluded retrograde transvenous obliteration (B‐RTO) for gastric varices (GV) in cirrhosis patients. Methods This retrospective study consisted of 37 cirrhosis patients (aged 62.5 ± 9.7 years) with medium‐ or large‐grade GV treated with B‐RTO. Portal hemodynamic response was assessed by the changes in flow volume in the portal trunk (PFV, mL/min) before and after the treatment. Group I showed increased PFV and group II showed no increase in PFV. The median observation period was 49.8 months (range, 4.7–150.3 months). Results All patients showed complete embolization of GV without any recurrence. There were 30 patients in group I and 7 patients in group II (decreased PFV in 6 and unchanged PFV in 1). The PFV at baseline was significantly lower in the former (583.5 ± 232.0 mL/min) than in the latter (880.7 ± 345.9 mL/min; P = 0.009). The survival rate was significantly lower in group II (83.3% at 1 year and 66.7% at 3 years) than in group I (96.7% at 1 year, 81.5% at 3 years, and 61.8% at 5 years; P = 0.012). The incidence of deterioration of the esophageal varices was 18/30 (60%) in group I and 5/7 (71.4%; P = 0.687) in group II. Multivariate analysis identified only no increase in portal response (hazard ratio, 8.086; P = 0.005) as an independent factor for poor prognosis. Conclusion Balloon‐occluded retrograde transvenous obliteration for GV may result in a poor prognosis when portal hemodynamics shows no increase in portal response.