Interventional procedure overview of transvenous obliteration for gastric varices

Article

Number of patients/ follow up

Direction of conclusions

Reasons for non-inclusion in summary of key evidence section

BRTO

Akahoshi T, Hashizume M, Tomikawa M et al. (2008) Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience. Journal of gastroenterology and hepatology 23(11):1702-9

n=68

FU=8 years

BRTO is beneficial over the long-term, despite worsening oesophageal varices in some patients, because of excellent treatment efficacy and improved mortality. BRTO can become a first-choice radical treatment following haemostasis for gastric variceal bleeding and prophylactic treatment for risky gastric varices.

Studies with more people or longer follow up included.

Arai H, Abe T, Takagi H and Mori M. (2006) Efficacy of balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices. World journal of gastroenterology 12(24):3866-73

n=75 BRTO, 8 PTO, 10 combined

FU=2.6 years

Combined BRTO and PTO therapy may rescue cases with uncontrollable gastric fundal varices that remained even after treatment with BRTO and/or PTO.

Studies with more people or longer follow up included.

Cho SK, Shin SW, Do YS et al. (2008) Development of thrombus in the major systemic and portal veins after balloon-occluded retrograde transvenous obliteration for treating gastric variceal bleeding: its frequency and outcome evaluation with CT. Journal of vascular and interventional radiology: JVIR 19 (4):529-38

n=60

FU=5 to 25 months

The frequency of thrombus development in the major systemic and portal veins after BRTO was 15%.

Safety outcome captured in included publications.

Chu HH, Kim M, Kim HC et al. (2018) Long-Term Outcomes of Balloon-Occluded Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: A Comparison of Ethanolamine Oleate and Sodium Tetradecyl Sulfate. Cardiovascular and interventional radiology 41(4):578-86

n=142

FU=19.9 months to 23.9 months (group means)

BRTO using sodium tetradecyl sulfate has comparable long-term outcomes to BRTO using ethanolamine oleate for gastric varices.

Studies with more people or longer follow up included.

Gimm G, Chang Y, Kim HC et al. (2018) Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding. Gut and liver 12(6):704-713

n=157

FU=8 years

BRTO provides better bleeding control, rebleeding-free survival, and OS than TIPS for patients with bleeding gastric varices.

Included in the Paleti (2020) systematic review and meta-analysis.

Imai Y, Nakazawa M, Ando S et al. (2016) Long-term outcome of 154 patients receiving balloon-occluded retrograde transvenous obliteration for gastric fundal varices.

Journal of gastroenterology and hepatology 31(11):1844-50

n=154

FU=30 months

Therapeutic strategies including B-RTO with a microballoon catheter were useful to achieve a favorable outcome in patients with gastric fundal varices especially in those manifesting Child-Pugh class-A liver damage and/or those without hepatocellular carcinoma complication.

Studies with more people or longer follow up included.

Jogo A, Nishida N, Yamamoto A et al. (2019) Selective Balloon-occluded Retrograde Transvenous Obliteration for Gastric Varices.

Internal medicine (Tokyo, Japan) 58 (16):2291-2297

n=104

FU=15 months to 23 months (group means)

Selective BRTO for GV could minimise the risk of a worsening of EV or reduce the amount of sclerosants; however, the rate of recurrence was high in comparison to conventional BRTO.

Studies with more people or longer follow up included.

Jogo A, Nishida N, Yamamoto A et al. (2014) Factors associated with aggravation of esophageal varices after B-RTO for gastric varices.

Cardiovascular and interventional radiology 37(5):1243-50

n=67

FU=1 year

Total bilirubin and hepatic venous pressure gradient were significant independent risk factors for oesophageal varices aggravation after BRTO.

Studies with more people or longer follow up included. Oesophageal varices aggravation well-described in the literature.

Jogo A, Yamamoto A, Kaminoh T et al. Utility of low-dose gelatin sponge particles and 5% ethanolamine oleate iopamidol mixture in retrograde transvenous obliteration (GERTO) for gastric varices.

The British journal of radiology 93(1108):20190751

n=57

FU=12 to 16 months (group means)

GERTO was performed in lower amount of sclerosants and in less time compared to conventional BRTO in Hirota's grade 2 or more.

Studies with more people or longer follow up included.

Kamezaki H, Maruyama H, Shimada T et al. (2013) Short- and long-term clinical outcome after balloon-occluded retrograde transvenous obliteration: Is pretreatment portal flow direction a predictive factor? Hepatology International 7(1):241-7.

n=103

FU=2.1 to 3.4 years (group means)

Haemodynamic assessment of portal flow direction is important before BRTO, and care should be taken to manage thrombotic disorders in the perioperative period in patients with reversed portal flow after BRTO. Another treatment option might be preferred for gastric varices in Child classes B and C patients with reversed portal flow instead of B-RTO, which may have a poor prognosis.

Studies with more people or longer follow up included.

Kiyosue H, Mori H, Maruno M et al. (2020) Conventional versus selective balloon-occluded retrograde transvenous obliteration of gastric varices. Egyptian Journal of Radiology and Nuclear Medicine 51(1):101

n=59

Selective and super-selective techniques had a lower ascites exacerbation, and oesophageal varices aggravation rates than conventional technique. However, superselective BRTO had a lower gastric varices complete thrombosis and higher gastric varices bleeding rates after BRTO than other techniques

Studies with more people or longer follow up included.

Lee SJ, Kim SU, Kim M-D et al. (2017) Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis. Journal of gastroenterology and hepatology 32(8):1487-1494

n=95

FU=3 years

BRTO proved more effective than TIPS in haemostasis of gastric variceal bleeding, associated with significantly less risk of re-bleeding.

Included in the Paleti (2020) systematic review and meta-analysis.

Maruyama H, Okugawa H, Kobayashi S et al. (2010) Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices.

European journal of radiology 75(2):e32-7

n=81

FU=3.5 years

Pre-treatment flow volume ratio between gastric vein and portal trunk before BRTO may be a predictive indicator for prognosis in cirrhotic patients with gastric fundal varices after BRTO.

Studies with more people or longer follow up included.

Mukund A, Rangarh P, Patidar Y et al (2020) Salvage Balloon Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleed in Cirrhotic Patients With Endoscopic Failure to Control Bleed/Very Early Rebleed: Long-term Outcomes. Journal of Clinical and Experimental Hepatology; 10(5):421-8

n=52

FU= 2 years

Salvage BRTO is a safe and effective procedure for patients with acute gastric variceal bleed with failure to control bleed with endotherapy or very early rebleed after endotherapy. Salvage BRTO has good short/long-term outcomes with lower rebleed, higher survival, and improved liver disease severity.

Studies with more people or longer follow up included.

Nakazawa M, Imai Y, Uchiya H et al. (2017) Balloon-occluded retrograde transvenous obliteration as a procedure to improve liver function in patients with decompensated cirrhosis. JGH Open 1(4):127-33

n=112

FU=6 months

BRTO is a useful therapeutic procedure for improving liver function even in patients without gastric varices by increasing the portal venous flow with successfully targeted, uncommon portosystemic shunts.

Studies with more people or longer follow up included.

Ninoi T, Nishida N, Kaminou T et al. (2005) Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. American journal of roentgenology 184(4):1340-6

n=78

FU=1.9 years

BRTO is an effective method for gastric varices with gastrorenal shunt and provides lower recurrence and bleeding rates.

Studies with more people or longer follow up included.

Ninoi T, Nakamura K, Kaminou T et al. (2004) TIPS versus transcatheter sclerotherapy for gastric varices. American

Journal of Roentgenology 183(2):369–76

n=58 BRTO, 28 PTS

FU=41.2 months

Transcatheter sclerotherapy may provide better control of gastric variceal bleeding than TIPS. Transcatheter sclerotherapy may contribute to a higher survival rate than TIPS in patients with Child-Pugh class A disease.

Studies with more people or longer follow up included.

Oshita K, Ohira M, Honmyo N et al. (2020) Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: a propensity score-weighted analysis from a single institution.

Journal of gastroenterology 55(9):877-87

n=55

FU=3 years

Splenectomy with gastric devascularization showed better overall survival and improvement of liver function compared with BRTO for the treatment of gastric varices caused by portal hypertension.

Studies with more people or longer follow up included.

Park SJ, Chung JW, Kim H-C et al. (2010) The prevalence, risk factors, and clinical outcome of balloon rupture in balloon-occluded retrograde transvenous obliteration of gastric varices.

Journal of vascular and interventional radiology: JVIR 21(4):503-7

n=69

Balloon rupture during BRTO occurred in 8.7% of patients. Balloon rupture may cause rapid migration of sclerosant, pulmonary embolism, and recurrent gastric variceal bleeding.

Safety outcome captured in included publications.

Saad WEA, Nicholson D, Lippert A et al (2012) Balloon-occlusion catheter rupture during balloon-occluded retrograde transvenous obliteration of gastric varices utilizing sodium tetradecyl sulfate: incidence and consequences. Vascular and endovascular surgery 46(8):664-70

n=40

The incidence of balloon-occlusion catheter rupture utilizing 3% sodium tetradecyl sulfate (STS) and inventory unique to the United States is significantly higher than in Asia (<8% rupture rate). However, these ruptures have no significant technical or clinical consequences.

Safety outcome captured in included publications.

Sonomura T, Ono W, Sato M et al. (2012) Three benefits of microcatheters for retrograde transvenous obliteration of gastric varices. World journal of gastroenterology 18(12):1373-8

n=56

FU=10.5 months

The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedure.

Studies with more people or longer follow up included.

Shiba M, Higuchi K, Nakamura K, et al. (2002) Efficacy and safety of balloon-occluded endoscopic injection sclerotherapy as a prophylactic treatment for high-risk gastric fundal varices: a prospective, randomized, comparative clinical trial. Gastrointest Endosc. 56(4):522-8

n=20 (BRTO and sclero-therapy groups)

The gastric varices in all people except one in the BRTO group were eradicated with either treatment. Balloon-occluded endoscopic injection sclerotherapy is a safe and effective for treatment of high-risk gastric fundal varices. In contrast to BRTO, it can be used even in patients without a gastrorenal shunt.

Larger RCT (Luo, 2021) included.

Stein DJ, Salinas C, Sabri S et al. (2019) Balloon Retrograde Transvenous Obliteration Versus Endoscopic Cyanoacrylate in Bleeding Gastric Varices: Comparison of Rebleeding and Mortality with Extended Follow-up.

Journal of vascular and interventional radiology: JVIR 30(2):187-194

n=71

FU=1 year

BRTO is associated with a lower rate of rebleeding but no change in mortality.

Studies with more people or longer follow up included.

Takaji R, Kiyosue H, Matsumoto S et al. (2011) Partial thrombosis of gastric varices after balloon-occluded retrograde transvenous obliteration: CT findings and endoscopic correlation. American journal of roentgenology 96(3):686-91

n=69

FU=32 months

Partial thrombosis after BRTO can occur in complex-type gastric varices, which have a higher risk of regrowth. Additional techniques that achieve complete thrombosis are required for long-term efficacy for complex-type gastric varices.

Studies with more people or longer follow up included.

Waguri N, Osaki A, Watanabe Y et al. (2021) Balloon-occluded retrograde transvenous obliteration for gastric varices improves hepatic functional reserve in long-term follow-up. JGH Open 5(12):1328-34

n=60

FU=3 years (up to 10 year survival analysis)

BRTO for gastric fundal varices has a favourable effect on long-term hepatic functional reserve.

Studies with more people or longer follow up included.

Wang YB, Zhang JY, Gong JP et al. (2016) Balloon-occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: A meta-analysis. Journal of gastroenterology and hepatology 31(4):727-33

n=5 studies, 210 patients

BRTO was a technically feasible as well as a secure method for the treatment of gastric varices originated from portal hypertension. It may have the potential to be an alterative shunt approach of TIPS, when suitable patients selected.

More recent systematic review and meta-analysis included.

Wang ZW, Liu JC, Zhao F et al. (2020) Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis. Canadian journal of gastroenterology & hepatology: 5143013

n=9 studies

In this meta-analysis, BRTO brought more benefits to patients, with a higher OS rate and lower rebleeding rate. BRTO is a feasible method for gastric varices.

Lower-quality systematic review and meta-analysis than Paleti, 2020. Similar findings.

Yamagami T, Yoshimatsu R, Miura H et al. (2013) The role of divided injections of a sclerotic agent over two days in balloon-occluded retrograde transvenous obliteration for large gastric varices. Korean journal of radiology 14(3):439-45

n=50

FU=51.2 months

When gastric varices are very large, a strategy involving thrombosis of only the drainage vein on the first day followed by infusing the sclerotic agent on the following day might be effective and feasible.

Studies with more people or longer follow up included.

Yamamoto A, Nishida N, Morikawa H et al. (2016) Prediction for Improvement of Liver Function after Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices to Manage Portosystemic Shunt Syndrome. Journal of vascular and interventional radiology: JVIR 27(8):1160-7

n=50

The predictive factor for improvement in albumin after BRTO was lower liver stiffness measurement (22.9 kPa or more) using transient elastography.

Studies with more people or longer follow up included.

Yoshimatsu R, Yamagami T, Miura H, and Hashiba M. (2015) Factors related to thrombosis of gastric varix during balloon-occluded retrograde transvenous obliteration.

Acta radiologica (Stockholm, Sweden: 1987) 56(5):592-7

n=65

Liver function might influence the development of thrombosis of gastric varices in BRTO. Serum albumin and prothrombin time-international normalised ratio levels would provide information for deciding on the duration of retention of the BRTO catheter to obtain sufficient therapeutic effectiveness.

Studies with more people or longer follow up included.

Yu Q, Liu C, and Raissi D. (2021) Balloon-occluded Retrograde Transvenous Obliteration Versus Transjugular Intrahepatic Portosystemic Shunt for Gastric Varices: A Meta-Analysis. Journal of clinical gastroenterology 55(2):147-158

n=5 studies, 308 patients

Both BRTO and TIPS are safe and effective interventions in the management algorithm of portal hypertensive gastric variceal bleeding. Although BRTO may be more effective at the prevention of future variceal rebleeding, the choice of BRTO versus TIPS should be tailored according to patient's comorbidities.

More comprehensive systematic review and meta-analysis included.

BATO

Ambati C, Boshell D, Ende J et al. (2021) The Promise of Percutaneous Transhepatic Variceal Embolization for Both Gastroesophageal and Ectopic Varices-An Australian Case Series. Journal of Clinical Interventional Radiology ISVIR 5(1):3-10

n=8

FU=44 days

Percutaneous transhepatic variceal embolization is an effective treatment option for patients with uncontrolled variceal bleeding (ectopic as well as gastroesophageal) especially when the traditional therapies such as transjugular intrahepatic portosystemic shunts, endoscopic variceal ligation, and BRTO are contraindicated or ineffective.

Studies with more people or longer follow up included.

Chikamori F, Kuniyoshi N, Kawashima T et al. (2006) Percutaneous transhepatic obliteration for isolated gastric varices with gastropericardiac shunt: case report. Abdominal imaging 31(2):249-52

n=1

Percutaneous transhepatic obliteration using a microcatheter is a rational, effective, and safe therapy for isolated gastric varices with a gastropericardiac shunt.

Studies with more people or longer follow up included.

Hirose S, Hasegawa N, Endo M et al. (2021) Percutaneous transhepatic obliteration-related procedures for isolated gastric varices: experience of three cases. Clinical Journal of Gastroenterology

n=3

PTO-related procedures are good treatment options for isolated gastric varices, but clinicians should be aware of the risk of treatment failure, especially the cases which have multiple feeding veins.

Studies with more people or longer follow up included.

Ishikawa T, Imai M, Ko M et al. (2017) Percutaneous transhepatic obliteration and percutaneous transhepatic sclerotherapy for intractable hepatic encephalopathy and gastric varices improves the hepatic function reserve Biomedical Reports 6(1):99-102

n=26

FU=6 months

For patients with various gastrorenal shunts or those with BRTO-intractable hepatic encephalopathy and gastric varices without gastrorenal shunts, PTO/PTS can improve the antegrade blood flow to the liver, as demonstrated by improvement in the hepatic function reserve.

Studies with more people or longer follow up included.

Kakio T, Ito T, Sue K et al. (1993) Hemostasis of gastric variceal hemorrhage by transileocoecal and transhepatic obliteration.

Acta medica Okayama 47(1):39-43

n=8

TIO and PTO seem to be safe, effective procedures to stop bleeding from ectopic varices, gastric or duodenal. This therapy is useful either to obtain accurate information about the varices or to obliterate the collateral veins in patients with ruptured ectopic varices.

Studies with more people or longer follow up included.

Kawai N, Minamiguchi H, Sato M et al. (2013) Percutaneous transportal outflow-vessel-occluded sclerotherapy for gastric varices unmanageable by balloon-occluded retrograde transvenous obliteration. Hepatology Research 43(4):430-5

n=2

FU=1 year

Although PTOS is slightly more invasive than BRTO, PTOS can be used as an alternative catheter treatment procedure for gastric varices that are unmanageable by BRTO

Studies with more people or longer follow up included.

Kwak HS and Han YM. (2008) Percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate for gastric varices: technique and clinical efficacy. Korean journal of radiology 9(6):526-33

n=7

FU=14.8 months

Percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate is useful to obliterate gastric varices if it is not possible to perform BRTO.

Studies with more people or longer follow up included.

Liu J, Yang C, Huang S et al. (2020) The combination of balloon-assisted antegrade transvenous obliteration and transjugular intrahepatic portosystemic shunt for the management of cardiofundal varices hemorrhage. European journal of gastroenterology & hepatology 32(5):656-62

n=15

FU=6 months

For the treatment of gastric varices, the new technique balloon-assisted antegrade transvenous obliterationis feasible, safe and effective, and it may be a more convenient and economical method than conventional BRTO.

Combination of techniques used.

Mohan PP, Ahlman PP and Beltran-Perez J. (2019) Gastric variceal hemorrhage treated with percutaneous transhepatic embolization with balloon-occluded antegrade transvenous obliteration. International Journal of Gastrointestinal Intervention 8(4):165-7

n=1

The patient was successfully managed by percutaneous transhepatic coil embolization combined with BRTO. It is of great importance to obtain an accurate cross-sectional image to evaluate the anatomical variances of gastric varices that will lead to appropriate vascular access and to choose a suitable embolisation method.

Studies with more people or longer follow up included.

Uchiyama F, Murata S, Onozawa S et al. (2013) Management of gastric varices unsuccessfully treated by balloon-occluded retrograde transvenous obliteration: long-term follow-up and outcomes. The Scientific World Journal: 498535

n=13

FU=90 months

Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

Studies with more people or longer follow up included.

Wang J, Tian XG, Li Y et al. (2013) Comparison of modified percutaneous transhepatic variceal embolization and endoscopic cyanoacrylate injection for gastric variceal rebleeding.

World journal of gastroenterology 19(5)

n=32

FU=21.5 months

With extensive and permanent obliteration of gastric varices and its feeding veins, percutaneous transhepatic variceal embolisation with 2-OCA is superior to endoscopic 2-OCA injection for preventing gastric variceal rebleeding.

Studies with more people or longer follow up included.

Yoshimatsu R, Yamagami T, Miura H, and Okuda K. Percutaneous transhepatic sclerotherapy with embolization of the drainage vein for a gastric varix. Acta Radiologica Short Reports 3(7)

n=1

A case with a gastric varix that did not have a catheterizable main drainage vein and had multiple afferent veins. For this case we successfully performed percutaneous transhepatic sclerotherapy.

Studies with more people or longer follow up included.

CARTO

Lee EW, Saab S, Gomes AS et al. (2014) Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results. Clinical and translational gastroenterology 5

n=20

FU=384 days

CARTO appears to be a technically feasible and safe alternative to traditional balloon-occluded retrograde transvenous obliteration or transjugular intrahepatic portosystemic shunt, with excellent clinical outcomes in treating portal hypertensive non-oesophageal variceal bleeding.

Non-gastric varices included.

Liu C, Han X, Ding P, and Lee EW. (2021) Coil-assisted retrograde transvenous obliteration for gastric varices in a Chinese case. Journal of Interventional Medicine 4 (2):94-6

n=1

FU=3 months

A Chinese case of portal hypertensive GV bleeding treated using CARTO with a coil and gelfoam slurry. Advantages of this technique include avoiding indwelling balloon catheters and complications related to sclerosant use. CARTO may have great potential to be widely accepted for the treatment of bleeding gastric varices in China.

Studies with more people or longer follow up included.

Soape MP, Lichliter A, Asrani SK et al. (2018) Uncoiling the Coil: Coil Extrusion After Coil Assisted Retrograde Transvenous Obliteration for Gastric Variceal Bleeding. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 16(5):e59

n=1

Case report of a migration of a coil into the stomach after CARTO.

Studies with more people or longer follow up included. Migration of embolising material already captured as an outcome.

Terada K, Ogi T, Yoneda N et al. (2020) Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of gastric varices via a single access route using steerable microcatheter: a case report. CVIR Endovascular 3(1):30

n=1

CARTO has advantages over BRTO in cases where performing BRTO is difficult, while CARTO is more expensive than BRTO. Using a steerable microcatheter simplifies the procedure by reducing the required access routes in CARTO.

Studies with more people or longer follow up included.

Uotani K, Matsushiro E, Hamanaka A et al. (2020) Modified Coil-Assisted Retrograde Transvenous Obliteration (m-CARTO) for Gastric Varices. CardioVascular and Interventional Radiology 43(7):1100-2

n=4

FU=24.8 months

M-CARTO enabled downgrading in cases in which advancing balloon-catheters deep into the gastrorenal shunt was difficult. The disadvantages of m-CARTO are the cost of the

microcoils and the second microcatheter, and prolonged procedure time compared with conventional BRTO.

Studies with more people or longer follow up included.

PARTO

Chang MY, Kim MD, Kim T et al. (2016) Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage. Korean journal of radiology 17(2):230-8

n=19

FU=11 months

PARTO is technically feasible, safe, and effective for gastric variceal haemorrhage in patients with portal hypertension.

Studies with more people or longer follow up included.

Gwon Dl, Ko GY, Kwon YB et al. (2018) Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: The Role of Intra-Procedural Cone-Beam Computed Tomography. Korean journal of radiology 19(2): 223-9

n=17

FU=193 days

PARTO is technically and clinically effective for the treatment of GV.

Studies with more people or longer follow up included.

Gwon DI, Ko GY, Yoon HK et al. (2013) Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report. Radiology 268(1):281-7

n=13

FU=422 days

Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of gastric varices.

Studies with more people or longer follow up included.

Gwon DI, Kim YH, Ko GY et al. (2015) Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices and Hepatic Encephalopathy: A Prospective Multicenter Study. Journal of vascular and interventional radiology: JVIR 26(11):1589-95

n=57

FU=544 days

PARTO can be rapidly performed with high technical success and durable clinical efficacy for the treatment of gastric varices and hepatic encephalopathy in the presence of a portosystemic shunt. Therefore, PARTO might be considered a first-line treatment in appropriate patients.

Outcomes for people with gastric varices and for people with hepatic encephalopathy are not presented separately.

Jang JY, Jeon UB, Kim JH et al. (2021) Plug-assisted retrograde transvenous obliteration via gastrocaval shunt for the gastric variceal bleeding: A case report. Medicine (United States) 100(49):e28107

n=1

FU=9 months

The gastric varix completely disappeared. The patient did not experience any additional bleeding events. PARTO via a gastrocaval shunt is safe and effective.

Studies with more people or longer follow up included.

Kim T, Yang H, Lee CK, and Kim GB. (2016) Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting. Yonsei medical journal 57(4):973-9

n=9

FU=17 months

Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.

Studies with more people or longer follow up included.

Mukund A, Anandpara KM, Ramalingam R et al. (2020) Plug-Assisted Retrograde Transvenous Obliteration (PARTO): Anatomical Factors Determining Procedure Outcome. Cardiovascular and interventional radiology 43 (10):1548-56

n=50

Knowledge of various anatomical factors of gastro-lieno-renal shunt may help in deciding the access route for PARTO and may determine technical success/failure. Alternate methods like BRTO or CARTO or anterograde obliteration of the shunt via trans-hepatic/splenic route might be needed in such circumstances.

Studies with more people or longer follow up included.

Tsauo J, Noh SY, Shin JH et al. (2021) Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with portal vein thrombosis: a multicenter study. European radiology 31(1):559-66

n=45 (27 PARTO, 18 BRTO)

FU=5.4 months

RTO may be effective for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis.

Studies with more people or longer follow up included.

Tsauo J, Noh SY, Shin JH et al. (2021) Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with hepatocellular carcinoma: a multicentre retrospective study. Clinical radiology 76(9):681-7

n=79 (32 BRTO, 40 PARTO, 1 CARTO)

FU=6.3 months

RTO was effective and safe in preventing variceal rebleeding in patients with hepatocellular carcinoma.

Studies with more people or longer follow up included.