Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis

Shin Jae Lee, Seung Up Kim, Man Deuk Kim, Young Hwan Kim, Gyoung Min Kim, Sung Il Park, Jong Yun Won, Do Yun Lee, Kwang Hun Lee

Research output: Contribution to journalArticle

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Abstract

Background and Aim: Both balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB. Methods: A total of 142 patients undergoing BRTO (n = 95) or TIPS (n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review. Results: Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause (n = 63, 44.4%), followed by hepatitis B (n = 60, 42.3%) and hepatitis C (n = 7, 4.9%) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1%) patients. During the follow-up period (mean, 28.2 months), 27 patients (19%) experienced re-bleeding. Cumulative re-bleeding rates after BRTO (8.6% at 1 year; 22.7% at 3 years) were significantly lower than those after TIPS (19.8% at 1 year; 48.2% at 3 years; P = 0.006, log-rank test). In multivariate analysis, TIPS (vs BRTO) was found independently predictive of re-bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child–Pugh score (both P < 0.05). Although BRTO surpassed TIPS (P = 0.026, log-rank test) in terms of overall postprocedural survival, independent factors predictive of poor overall survival after hemostasis were concurrent HCC (HR = 3.106), high Child–Pugh score (HR = 1.886 per 1-point increase), and postprocedural hepatic encephalopathy (HR = 3.014; all P < 0.05). Conclusion: Balloon-occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re-bleeding.

Original languageEnglish
Pages (from-to)1487-1494
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume32
Issue number8
DOIs
Publication statusPublished - 2017 Aug

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Transjugular Intrahepatic Portasystemic Shunt
Hemostasis
Stomach
Hemorrhage
Hepatocellular Carcinoma
Alcoholic Liver Cirrhosis
Survival
Hepatic Encephalopathy
Virus Diseases
Hepatitis C
Hepatitis B
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

@article{30e248ab61ca469097d58a3bd49c3a0f,
title = "Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis",
abstract = "Background and Aim: Both balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB. Methods: A total of 142 patients undergoing BRTO (n = 95) or TIPS (n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review. Results: Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause (n = 63, 44.4{\%}), followed by hepatitis B (n = 60, 42.3{\%}) and hepatitis C (n = 7, 4.9{\%}) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1{\%}) patients. During the follow-up period (mean, 28.2 months), 27 patients (19{\%}) experienced re-bleeding. Cumulative re-bleeding rates after BRTO (8.6{\%} at 1 year; 22.7{\%} at 3 years) were significantly lower than those after TIPS (19.8{\%} at 1 year; 48.2{\%} at 3 years; P = 0.006, log-rank test). In multivariate analysis, TIPS (vs BRTO) was found independently predictive of re-bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child–Pugh score (both P < 0.05). Although BRTO surpassed TIPS (P = 0.026, log-rank test) in terms of overall postprocedural survival, independent factors predictive of poor overall survival after hemostasis were concurrent HCC (HR = 3.106), high Child–Pugh score (HR = 1.886 per 1-point increase), and postprocedural hepatic encephalopathy (HR = 3.014; all P < 0.05). Conclusion: Balloon-occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re-bleeding.",
author = "Lee, {Shin Jae} and Kim, {Seung Up} and Kim, {Man Deuk} and Kim, {Young Hwan} and Kim, {Gyoung Min} and Park, {Sung Il} and Won, {Jong Yun} and Lee, {Do Yun} and Lee, {Kwang Hun}",
year = "2017",
month = "8",
doi = "10.1111/jgh.13729",
language = "English",
volume = "32",
pages = "1487--1494",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
issn = "0815-9319",
publisher = "Wiley-Blackwell",
number = "8",

}

Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis. / Lee, Shin Jae; Kim, Seung Up; Kim, Man Deuk; Kim, Young Hwan; Kim, Gyoung Min; Park, Sung Il; Won, Jong Yun; Lee, Do Yun; Lee, Kwang Hun.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 32, No. 8, 08.2017, p. 1487-1494.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis

AU - Lee, Shin Jae

AU - Kim, Seung Up

AU - Kim, Man Deuk

AU - Kim, Young Hwan

AU - Kim, Gyoung Min

AU - Park, Sung Il

AU - Won, Jong Yun

AU - Lee, Do Yun

AU - Lee, Kwang Hun

PY - 2017/8

Y1 - 2017/8

N2 - Background and Aim: Both balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB. Methods: A total of 142 patients undergoing BRTO (n = 95) or TIPS (n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review. Results: Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause (n = 63, 44.4%), followed by hepatitis B (n = 60, 42.3%) and hepatitis C (n = 7, 4.9%) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1%) patients. During the follow-up period (mean, 28.2 months), 27 patients (19%) experienced re-bleeding. Cumulative re-bleeding rates after BRTO (8.6% at 1 year; 22.7% at 3 years) were significantly lower than those after TIPS (19.8% at 1 year; 48.2% at 3 years; P = 0.006, log-rank test). In multivariate analysis, TIPS (vs BRTO) was found independently predictive of re-bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child–Pugh score (both P < 0.05). Although BRTO surpassed TIPS (P = 0.026, log-rank test) in terms of overall postprocedural survival, independent factors predictive of poor overall survival after hemostasis were concurrent HCC (HR = 3.106), high Child–Pugh score (HR = 1.886 per 1-point increase), and postprocedural hepatic encephalopathy (HR = 3.014; all P < 0.05). Conclusion: Balloon-occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re-bleeding.

AB - Background and Aim: Both balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB. Methods: A total of 142 patients undergoing BRTO (n = 95) or TIPS (n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review. Results: Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause (n = 63, 44.4%), followed by hepatitis B (n = 60, 42.3%) and hepatitis C (n = 7, 4.9%) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1%) patients. During the follow-up period (mean, 28.2 months), 27 patients (19%) experienced re-bleeding. Cumulative re-bleeding rates after BRTO (8.6% at 1 year; 22.7% at 3 years) were significantly lower than those after TIPS (19.8% at 1 year; 48.2% at 3 years; P = 0.006, log-rank test). In multivariate analysis, TIPS (vs BRTO) was found independently predictive of re-bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child–Pugh score (both P < 0.05). Although BRTO surpassed TIPS (P = 0.026, log-rank test) in terms of overall postprocedural survival, independent factors predictive of poor overall survival after hemostasis were concurrent HCC (HR = 3.106), high Child–Pugh score (HR = 1.886 per 1-point increase), and postprocedural hepatic encephalopathy (HR = 3.014; all P < 0.05). Conclusion: Balloon-occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re-bleeding.

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DO - 10.1111/jgh.13729

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VL - 32

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JO - Journal of Gastroenterology and Hepatology (Australia)

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