Predicting difficulty of balloon-occluded retrograde transvenous obliteration in gastric varices: Collateral pathways closure is affected by the inflow rate from the left gastric vein

Abstract

Balloon-occluded retrograde transvenous obliteration (B-RTO) was attempted in 19 cases of solitary gastric varices at our institution. Patients were divided based on the cause of the difficulty with closure of the collateral pathway to investigate how they affected the success or failure of the procedure. When left gastric venous reflux was imaged during B-RTO, the surgical success rate was lower than when reflux was not observed. Stratification based on the degree of reflux resulted in a positive correlation between surgical completion rates and the approximate ratio (left gastric vein diameter²/gastric varices diameter²) of left gastric venous flow into the gastric varices. Once this ratio exceeded approximately 0.45, closure of the collateral pathway became difficult, and B-RTO could not be completed. When the left gastric vein provides an alternative entry pathway, it may cause backflow during B-RTO forming a collateral pathway that cannot be closed off. The above ratio may provide an indicator to predict the difficulty of collateral pathway closure prior to B-RTO.