Summary of key evidence on CARTO for gastric varices

Study 8 Yamamoto A (2020)

Study details

Study type	Retrospective, single centre, case series
Country	Japan
Recruitment period	2016 to 2018
Study population and number	n=36 Consecutive people with gastric varices who had CARTO-II (see Technique below)
Age and sex	Mean 64.7 years; 56% male
Patient selection criteria	Consecutive people with gastric varices who had CARTO-II. People were excluded for: emergent BRTO (n=3), high wedge pressure of the hepatic vein (45 mmHg) after temporary occlusion of the gastrorenal shunt (n=1), did not undergo BRTO because of visualisation of apparent portopulmonary vein anastomosis during the procedure (n=1).
Technique	CARTO-II is a modified BRTO technique in which coils and a balloon catheter are used. Under local anaesthesia, a balloon catheter is inserted into the gastrorenal shunt. Venography was performed to visualise the varices. Ethanolamine oleate and iopamidol was used to embolise the varices. Then, coil embolisation of the drainage vein was performed through the balloon catheter.
Follow up	Mean 207 days (range 3 to 675 days)
Conflict of interest/source of funding	Conflict of interest: The authors declare that they have no conflict of interest. Source of funding: Not reported.

Study design issues: This retrospective case series assessed the outcomes of a modified CARTO procedure, CARTO-II, for the treatment of gastric varices. Consecutive people were identified retrospectively from medical records. Outcomes included:

Technical success, defined as blood flow stagnation on venograms obtained immediately after final balloon deflation.
Clinical success, defined as absence of recurrence after CARTO-II.
Survival.
Complications.

No statistical analysis was performed.

Study population issues: The aetiology was alcohol in 13 (36%), non-alcoholic fatty liver disease in 7 (19%), hepatitis B in 5 (14%), hepatitis C in 4 (11%), Fontan-associated liver disease in 1 (3%), primary biliary cirrhosis in 1 (3%), Wilson disease in 1 (3%), extra-hepatic portal vein obstruction in 1 (3%), and unknown in 3 (8%). There were 28 people classified as Child-Pugh grade A and 8 as grade B. The form of gastric varices was F1 in 1 person (2%), F2 in 29 (82%), and F3 in 6 (16%). The Hirota grade of varices was 1 in 5 people (14%), 2 in 12 (33%), 3 in 11 (31%), and 4 in 8 (22%).