Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects
Table 2
Overview of recent studies on efficacy and safety of portosystemic shunt embolization for gastric variceal bleeding.
Authors, year
n
Technique; success rate
Follow-up
Complications
Comments
Sabri et al, 2014
50
BRTO: 91%
18.2 months (mean)
9% (2 of 23); hospital-acquired pneumonia, pulmonary embolism (treated medically).
Study comparing BRTO and TIPS for GV. No recurrence of GV bleed in the BRTO group; 11% in TIPS group. HE in 15% of TIPS group; none in BRTO group.
Kim et al, 2016
95
BRTO, PARTO; 94.7%
12 months (mean)
Hemoglobinuria in 1 patient and death in one patient due to DIC in the BRTO-EO group. No major complications in the other 2 groups.
Less complications with BRTO using STS foam or PARTO compared to BRTO using EO. Recurrence more common with PARTO. Shortest procedure time with PARTO.
Chang et al, 2016
19
PARTO; 94.7%
11 months (median)
7 minor complications (fever, hypotension, microscopic hematuria). EV (new onset or aggravated) in 5 patients, one died at 7 months due to EV bleed.
No recurrence of GV bleed in any patient.
Kim et al, 2017
52
BRTO; 88%
727 days (mean)
Balloon rupture in 2 patients, common femoral artery injury requiring arteriotomy in 1 patient.
Study comparing BRTO and TIPS for GV. No significant difference in procedural complications, rebleeding rates, new onset ascites or mean survival between the two groups. HE more common in TIPS group.
Lee et al, 2017
142
BRTO; 86.2%
28.2 months (mean)
Pulmonary edema in 1 patient (recovered). HE in 30% of patients in TIPS group; none in BRTO group. Exacerbation of ascites in 14% of patients in BRTO group; 4% in TIPS group.
Study comparing BRTO and TIPS for GV. Lower rebleeding rates and better overall postprocedure survival rates after BRTO.
Gimm et al, 2018
176
BRTO; 95.7%
NA
No difference in procedural complications, aggravation of ascites, EV, pleural effusion, HE. Progression of ascites higher in BRTO group.
Study comparing BRTO and TIPS for GV. Better overall survival and rebleeding-free survival with BRTO.
