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Balloon-occluded retrograde transvenous obliteration

From Wikipedia, the free encyclopedia
Balloon-occluded retrograde transvenous obliteration
Other namesBRTO
SpecialtyInterventional radiology

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular procedure used for the treatment of gastric varices. When performing the procedure, an interventional radiologist accesses blood vessels using a catheter, inflates a balloon (e.g. balloon occlusion) and injects a substance into the variceal blood vessels that causes blockage of those vessels. To prevent the flow of the agent out of the intended site (variceal blood vessels), a balloon is inflated during the procedure, which occludes.

Medical uses

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BRTO is used for the treatment of bleeding from gastric varices. In addition to transjugular intrahepatic portosystemic shunt (TIPS), BRTO is a first line treatment for the prevention of recurrent bleeding from gastric varices (GOV2 or IGV1).[1] BRTO may be used for the treatment of ectopic varices.[1]

Complications

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As BRTO results in a blockage of a portosystemic shunt, the procedure may result in increased portal hypertension, which may worsen esophageal varices or ascites.[2][1]

History

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BRTO was developed as a procedure in the early 1990s.[2] Initially, the procedure was performed using ethanolamine oleate as a sclerosant.[2][3] Between 2006 and 2007, American physicians began using sodium tetradecyl sulfate (3% STS) as an alternative sclerosing agent.[2][3]

See also

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References

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  1. ^ a b c Garcia-Tsao, G; Abraldes, JG; Berzigotti, A; Bosch, J (January 2017). "Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases". Hepatology. 65 (1): 310–335. doi:10.1002/hep.28906. PMID 27786365. S2CID 963110.
  2. ^ a b c d Saad, Wael (June 2012). "Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: Concept, Basic Techniques, and Outcomes". Seminars in Interventional Radiology. 29 (2): 118–128. doi:10.1055/s-0032-1312573. PMC 3444869. PMID 23729982.
  3. ^ a b Kobayakawa, M; Ohnishi, S; Suzuki, H (March 2019). "Recent development of balloon-occluded retrograde transvenous obliteration". Journal of Gastroenterology and Hepatology. 34 (3): 495–500. doi:10.1111/jgh.14463. PMID 30170340. S2CID 52141861.