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CASE REPORT

Isolated Gastric Varices and Use of Balloon-occlusive Retrograde Transvenous Obliteration: A Case Report and Literature Review*

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Thomas R. McCarty1, Mena Bakhit1, Tarun Rustagi2

1) Department of Internal Medicine, Yale University School of Medicine, New Haven, CT;
2) Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.251.mcc

ABSTRACT

Isolated gastric varices are far less prevalent in Western countries where the rate of splenic thrombosis is much lower. However, in Asian countries the entity is more common and therefore a more robust treatment approach has been developed. Balloon-occlusive retrograde transvenous obliteration (BRTO) was first described in 1984 and then revived in 1996. The procedure, while uncommon in the U.S. and not recognized by the AASLD practice guidelines, allows for direct exclusion from the portosystemic system. Here we describe the case of a patient with alcoholic cirrhosis decompensated by bleeding gastric varices treated with BRTO.

Key words: cirrhosis – gastric varices – BRTO – TIPS – balloon – variceal bleeding.

Abbrevations: BRTO: balloon-occlusive retrograde transverse obliteration; EGD: esophagogastro-duodenoscopy; HE: hepatic encephalopathy; MELD: Model for End Stage Liver Disease; TIPS: transjugular intrahepatic portosystemic shunt.