Effects of balloon-occluded retrograde transvenous obliteration (B-RTO) on esophageal varices were evaluated in 67 patients receiving successful procedures for isolated gastric varices. Esophageal varices were aggravated after B-RTO in 15 patients (22.4%) with cumulative aggravation rates of 15.3%, 22.9%, 29.3%, and 36.4% at 6 months, 1 year, 3 years, and 5 years, respectively. Among 34 patients without esophageal varices at baseline, esophageal varices developed after the procedures in 6 patients; F1 varices in 4 patients and F2 varices in 2 patients. Of 22 patients with F1 esophageal varices at baseline, the varices were aggravated to F2 varices in 6 patients. In contrast, of 11 patients with F2 esophageal varices at baseline, the varices were aggravated to F3 varices in 3 patients. Hemorrhage from esophageal varices occurred in 5 patients (7.5%). Multivariate analysis revealed that serum albumin levels less than 3.2g/dl were significantly associated with esophageal varices aggravation or development. Considering that esophageal varices developed or aggravated after B-RTO procedures regardless of the extents of preexisting esophageal varices in patients with isolated gastric varices, upper gastrointestinal endoscopic examinations should be done repeatedly from the early stage after the procedures, especially in cirrhotic patients manifesting serum albumin levels less than 3.2g/dl.