Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices

OBJECTIVE: Balloon-occluded retrograde transvenous obliteration is an effec tive new method for treating gastric fundal varices, but subsequent occurre nce of esophageal varices creates a problem. The relationship between porta l hemodynamics and the occurrence of esophageal varices after prophylactic balloon-occluded retrograde transvenous obliteration was investigated. METHODS: Ten cirrhotic patients considered to have high risk gastric fundal varices underwent angiography. Six patients showed a communication between blood flow in gastric wall vessels and that in the gastrorenal shunt (type I), whereas the others (type II) did not. Depending on the flow direction in the left gastric vein, the two groups were further divided into hepatope tal (a) and hepatofugal (b) subgroups. The therapeutic effect on portal hem odynamics and the relationship between pretreatment portal hemodynamics and posttreatment occurrence of esophageal varices were investigated. RESULTS: Fundal varices disappeared endoscopically in all 10 patients and t he gastrorenal shunt was also occluded after the procedure. No patient show ed worsening of liver function or systemic complications during follow-up. The increase in portal blood flow was more significant in type Ib patients than in the others. Esophageal varices occurred in all type I patients, and as to those in type Ib, high risk varices developed within 6 months after treatment. On the other hand, esophageal varices did not occur in type II p atients. CONCLUSIONS: This procedure was effective for treating gastric fundal varic es. However, type Ib patients are likely to develop high risk esophageal va rices after occlusion of the gastrorenal shunt. (Am J Gastroenterol 1999;94 : 643-649. (C) 1999 by Am. Cell. of Gastroenterology).