The Prevalence, Risk Factors, and Clinical Outcome of Balloon Rupture in Balloon-occluded Retrograde Transvenous Obliteration of Gastric Varices

Abstract

PURPOSE: To evaluate the prevalence, risk factors, and clinical outcome after balloon rupture during balloon-occluded retrograde transvenous obliteration (BRTO). MATERIALS AND METHODS: Sixty-nine patients who underwent the BRTO procedure from August 1999 to January 2009 were analyzed retrospectively. The occurrence of balloon rupture was recorded by a review of medical records and imaging studies. The chi(2) test was used to analyze risk factors for balloon rupture including balloon type and size, amount of sclerosant, and the use of microcatheters. The influence of balloon rupture on migration of the sclerosant and in-hospital mortality was analyzed with the Fisher exact test. RESULTS: The prevalence of balloon rupture was 8.7% (six of 69 patients). No significant risk factor for balloon rupture was identified because of the small number of balloon rupture cases. Migration of the sclerosant occurred in three patients with early balloon rupture within 1 hour. One of these patients died of recurrent gastric variceal bleeding and another experienced dyspnea and died of fungal sepsis. Among the 63 patients without rupture, no migration of the sclerosant was noted, and one patient died of sepsis caused by liver abscess. Incidences of sclerosant migration and in-hospital mortality were significantly higher in patients with balloon rupture versus patients without balloon rupture (P = .018 and P < .001, respectively). CONCLUSIONS: Balloon rupture during BRTO occurred in 8.7% of patients. Balloon rupture may cause rapid migration of sclerosant, pulmonary embolism, and recurrent gastric variceal bleeding.