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World J Hepatol. Jun 27, 2021; 13(6): 650-661
Published online Jun 27, 2021. doi: 10.4254/wjh.v13.i6.650
Balloon-occluded retrograde transvenous obliteration for treatment of gastric varices
Nobuo Waguri, Akihiko Osaki, Yusuke Watanabe
Nobuo Waguri, Akihiko Osaki, Yusuke Watanabe, Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1197, Japan
Author contributions: Waguri N wrote the manuscript; Osaki A drew the illustrations; Watanabe Y reviewed the paper.
Conflict-of-interest statement: There are no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nobuo Waguri, MD, PhD, Chief Doctor, Director, Department of Gastroenterology and Hepatology, Niigata City General Hospital, 467-3 Shumoku, Chuo-ku, Niigata 950-1197, Japan. waguri@hosp.niigata.niigata.jp
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: March 29, 2021
Revised: April 12, 2021
Accepted: May 22, 2021
Article in press: May 22, 2021
Published online: June 27, 2021
Abstract

Rupture of gastric varices (GVs) can be fatal. Balloon-occluded retrograde transvenous obliteration (BRTO), as known as retrograde sclerotherapy, has been widely adopted for treatment of GVs because of its effectiveness, ability to cure, and utility in emergency and prophylactic treatment. Simplifying the route of blood flow from GVs to the gastrorenal shunt is important for the successful BRTO. This review outlines BRTO indications and contraindications, describes basic BRTO procedures and modifications, compares BRTO with other GVs treatments, and discusses various combination therapies. Combined BRTO and partial splenic embolization may prevent exacerbation of esophageal varices and shows promise as a treatment option.

Keywords: Gastric varices, Balloon-occluded retrograde transvenous obliteration, Balloon-occluded antegrade transvenous obliteration, Partial splenic embolization, Transjugular intrahepatic portosystemic shunt, Plug- and coil-assisted retrograde transvenous obliteration

Core Tip: Gastric varices (GVs) are a common complication of liver cirrhosis and their rupture is often fatal. Balloon-occluded retrograde transvenous obliteration (BRTO) has been widely adopted for treatment of GVs because of its effectiveness, ability to cure, and utility in emergency and prophylactic treatment. Various modifications of BRTO and combinations with other therapies are also beneficial. Combined BRTO and partial splenic embolization shows promise as a treatment option.