Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices

Objective: Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRT0) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. Materials and Methods: We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRT0 between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRT0. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups. Results: There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRT0 (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7 % [2/27]; BRT0, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRT0, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRT0 (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRT0, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRT0, it was 26.6 months. Conclusion: BRT0 is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy.