Clinical Outcomes of Balloon-Occluded Versus Plug-Assisted Retrograde Transvenous Obliteration in the Treatment of Gastric Varices

Abstract

Purpose: To compare balloon-occluded retrograde transvenous obliteration (BRTO) using sodium tetradecyl sulfate and plug-assisted retrograde transvenous obliteration (PARTO), for treating symptomatic gastric varices. Materials and methods: A retrospective review of 51 consecutive patients (age: 63.7 ± 12.1 years; male: 72.6%) who underwent retrograde transvenous obliteration for gastric varices between June 2018 and July 2023 was conducted. Patients underwent BRTO (n = 26) or PARTO (n = 25) according to the preference of the attending interventional radiologist. The primary endpoint was complete obliteration. Secondary endpoints included technical and clinical success, post-embolization syndrome (PES), complications, and recurrent bleeding. Results: Technical success was achieved in 100% of BRTO group and 96% of PARTO group. Clinical success was achieved in all patients with technical success. One major complication in the PARTO group was due to shunt rupture during sheath passage, requiring fluid resuscitation and blood transfusion. In the BRTO group, there was a minor complication involving a balloon rupture, but the patient remained asymptomatic. PES was more frequent in the PARTO group (56%) compared to the BRTO group (23.1%) (p = 0.034). The median follow-up duration was 7 months. Complete obliteration rate was significantly higher in the BRTO group (100%) than in the PARTO group (80%) (p = 0.023). Recurrent bleeding occurred in one patient with remnant varix in the PARTO group. Conclusions: Both techniques achieved high technical and clinical success rates in the treatment of symptomatic gastric varices. However, BRTO demonstrated higher complete variceal obliteration and lower PES, suggesting a clinical advantage over PARTO.