Long-term outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices: a comparison of ethanolamine oleate and sodium tetradecyl sulfate

Abstract

Purpose: This study was performed to compare the long-term outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices using ethanolamine oleate (EO) and sodium tetradecyl sulfate (STS). Methods: From January 2002 to June 2015, 142 patients underwent BRTO for the treatment of gastric varices using EO (n = 59) or STS (n = 83). We retrospectively reviewed the follow-up data related to the obliteration of gastric varices, rebleeding, and clinical complications. The cumulative recurrence rates of variceal bleeding after BRTO in each group were analyzed using the Kaplan–Meier method and compared using the log-rank test. Results: The median follow-up periods were 23.9 (range, 0.2–170.7) months in the BRTO with EO group and 19.9 (range, 0.2–84.7) months in the BRTO with STS group. Technical success was achieved in 53 of 59 (89.8%) cases in the BRTO with EO group and 80 of 83 (96.4%) cases in the BRTO with STS group. The clinical success rates were 94.9% (56/59) in the BRTO with EO group and 96.4% (80/83) in the BRTO with STS group. The cumulative 1-, 3-, and 5-year recurrence rates for gastric varices were 3.8%, 9.4%, and 9.4% in the BRTO with EO group and 1.3%, 2.5%, and 3.8% in the BRTO with STS group, respectively (p = 0.684). The cumulative 1-, 3-, and 5-year rebleeding rates of treated gastric varices were 0%, 3.6%, and 5.4% in the BRTO with EO group and 1.3%, 3.8%, and 3.8% in the BRTO with STS group, respectively (p = 0.863). In terms of minor complications, occlusion balloon rupture after the injection of the sclerosing agent developed in 5 of 59 patients in the only BRTO with EO group. Conclusion: BRTO using STS can achieve obliteration of gastric varices comparable to that of EO with a similar long-term outcome. In minor complication, occlusion balloon rupture was developed in only BRTO with EO group.