However, gelatin sponge is an absorbable agent that produces a temporary occlusion when used for gastric variceal embolization, leading to a greater likelihood of recanalization, as compared with a permanent agent such as EO. ( 15) reported a variant of BRTO, vascular plugassisted retrograde transvenous obliteration (PARTO), to overcome the drawbacks of BRTO using sclerosant by PARTO is an alternative endovascular treatment that uses a vascular plug and gelatin sponge particles instead of balloon occlusion of the gastrorenal shunt and a sclerosing agent. The sclerosing effect of STS foam is theoretically more rapid than EO, but problems associated with balloon catheter remain. In the absence of adequate EO concentrations and antidotes, 3% sodium tetradecyl sulfate (STS) has been used as the sclerosant of choice in the United States ( 14). Ethanolamine oleate (EO), the traditional sclerosing agent used in Japan and Korea, is associated with serious complications, such as pulmonary edema, disseminated intravascular coagulation, portal vein thrombosis, severe renal dysfunction, and anaphylactic reactions ( 5, 12, 13). However, as BRTO requires an occlusion balloon catheter and sclerosing agents to occlude the portosystemic shunt, the indwelling catheter results in long procedural times and complications associated with the balloon (e.g., balloon rupture) ( 11, 12, 13). Its advantages over TIPS include less invasiveness and greater performance ease in patients with poor hepatic reserve, encephalopathy, or refractory ascites ( 2, 7, 8). The BRTO technique has been described in many reports ( 4, 5, 6, 7) and has shown considerable effectiveness with low rebleeding rates ( 4, 5, 6, 7, 8, 9, 10).
However, TIPS may not be suitable for some patients with poor hepatic reserve, portal vein thrombosis, hepatic encephalopathy, or severe thrombocytopenia ( 1, 2, 3).īalloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique that was refined in Japan as a therapeutic adjunct or alternative to TIPS for management of gastric varices ( 4). When endoscopy fails to control gastric variceal bleeding, a transjugular intrahepatic portosystemic shunt (TIPS) is recommended to decompress the portal circulation ( 1, 2). Upper gastrointestinal endoscopy is usually the first-line diagnostic and management tool for bleeding gastric varices ( 1).
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