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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
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 patie...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Singapore
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289714/ https://www.ncbi.nlm.nih.gov/pubmed/32533300 http://dx.doi.org/10.1007/s00535-020-01693-9 |
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author | Oshita, Ko Ohira, Masahiro Honmyo, Naruhiko Kobayashi, Tsuyoshi Murakami, Eisuke Aikata, Hiroshi Baba, Yasutaka Kawano, Reo Awai, Kazuo Chayama, Kazuaki Ohdan, Hideki |
author_facet | Oshita, Ko Ohira, Masahiro Honmyo, Naruhiko Kobayashi, Tsuyoshi Murakami, Eisuke Aikata, Hiroshi Baba, Yasutaka Kawano, Reo Awai, Kazuo Chayama, Kazuaki Ohdan, Hideki |
author_sort | Oshita, Ko |
collection | PubMed |
description | 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 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 ≤3.6 g/dL, prothrombin time% activity (PT%) ≤80%, and serum creatinine level ≥0.84 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 hypertension. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00535-020-01693-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7289714 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Singapore |
record_format | MEDLINE/PubMed |
spelling | pubmed-72897142020-06-12 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 Oshita, Ko Ohira, Masahiro Honmyo, Naruhiko Kobayashi, Tsuyoshi Murakami, Eisuke Aikata, Hiroshi Baba, Yasutaka Kawano, Reo Awai, Kazuo Chayama, Kazuaki Ohdan, Hideki J Gastroenterol Original Article—Liver, Pancreas, and Biliary Tract 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 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 ≤3.6 g/dL, prothrombin time% activity (PT%) ≤80%, and serum creatinine level ≥0.84 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 hypertension. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00535-020-01693-9) contains supplementary material, which is available to authorized users. Springer Singapore 2020-06-12 2020 /pmc/articles/PMC7289714/ /pubmed/32533300 http://dx.doi.org/10.1007/s00535-020-01693-9 Text en © Japanese Society of Gastroenterology 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Article—Liver, Pancreas, and Biliary Tract Oshita, Ko Ohira, Masahiro Honmyo, Naruhiko Kobayashi, Tsuyoshi Murakami, Eisuke Aikata, Hiroshi Baba, Yasutaka Kawano, Reo Awai, Kazuo Chayama, Kazuaki Ohdan, Hideki 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 |
title | 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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Original Article—Liver, Pancreas, and Biliary Tract |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289714/ https://www.ncbi.nlm.nih.gov/pubmed/32533300 http://dx.doi.org/10.1007/s00535-020-01693-9 |
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