Balloon-occluded retrograde transvenous obliteration (BRTO) is a technique used by interventional radiologists in the treatment of gastric varices, particularly those with prominent infra-diaphragmatic portosystemic venous shunts (e.g. gastro-renal and gastro-caval shunts).
- The technique is more popular in Asia, where it is a first-line treatment for gastric variceal hemorrhage.
- The modified versions include balloon-occluded antegrade transvenous obliteration (BRTO), coil-assisted retrograde transvenous obliteration (CARTO), and vascular plug-assisted retrograde transvenous obliteration (PARTO).
- The advantages of PARTO include decreased procedure time, decreased post-procedure monitoring and removes the risks associated with an indwelling balloon catheter, i.e. rupture.
- TIPS (Transjugular Intrahepatic Portosystemic Shunt) is another valuable option in controlling esophageal (when endoscopy has failed) and gastric variceal bleeding. TIPS has proven very effective in acutely controlling both esophageal and gastric variceal hemorrhage.
Signs & Symptoms: BRTO is primarily utilized to address the following symptoms and conditions:
- Gastric Varices: Swollen veins in the stomach that can lead to potentially life-threatening bleeding.
- Portal Hypertension: Increased pressure in the portal vein, often associated with liver cirrhosis, which contributes to the development of gastric varices.
- Bleeding: Gastric varices can cause symptoms such as vomiting blood or passing bloody stools.
Investigation and Diagnosis
- Endoscopy
- Imaging Studies
Available Treatments:
- Balloon-Occluded Retrograde Transvenous Obliteration (BRTO)
- Endoscopic Therapy
- Transjugular Intrahepatic Portosystemic Shunt (TIPS)
