Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliterat
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ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT
Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: a propensity score-weighted analysis from a single institution Ko Oshita1 • Masahiro Ohira1,2 • Naruhiko Honmyo1 • Tsuyoshi Kobayashi1 Eisuke Murakami3,4 • Hiroshi Aikata3,4 • Yasutaka Baba5 • Reo Kawano6 • Kazuo Awai5 • Kazuaki Chayama3,4 • Hideki Ohdan1
•
Received: 4 August 2019 / Accepted: 2 June 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background Although balloon-occluded retrograde transvenous obliteration (BRTO) is often selected to treat gastric varices caused by portal hypertension, data comparing BRTO and splenectomy with gastric devascularization (Sp ? Dev) are limited. Methods From January 2009 to February 2018, 100 patients with gastric varices caused by portal hypertension who underwent Sp ? Dev (n = 45) or BRTO (n = 55) were included. Overall survival (OS) and the rebleeding rate were calculated using the inverse probability of a treatment weighting-adjusted log-rank test. Independent
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00535-020-01693-9) contains supplementary material, which is available to authorized users. & Masahiro Ohira [email protected] 1
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
2
Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
3
Department of Gastroenterology and Metabolisms, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
4
Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan
5
Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
6
Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
risk factors were identified by Cox regression analysis. Changes in liver function and adverse events after the procedures were analyzed. Results Patients in the Sp ? Dev group tended to have lower platelet counts than those in the BRTO group, but liver function did not differ between these groups. The 5-year OS rates for the Sp ? Dev and BRTO groups were 73.4 and 50.0% (p = 0.005), respectively. There were no significant differences in rebleeding rates between the two groups. Multivariate analysis showed that serum albumin level B3.6 g/dL, prothrombin time% activity (PT%) B80%, and serum creatinine level C0.84 mg/dL were poor prognostic factors. Although the Sp ? Dev group had more short-term complications after procedures, Sp ? Dev tended to be more effective in improving liver function than BRTO. Conclusions Sp ? Dev showed better OS and improvement of liver function compared with BRTO for the treatment of gastric varices caused by portal
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