A Combined Treatment of Life-threatening and Difficult to Treat Bleeding Gastro-oesophageal Varices in a Patient with Cirrhosis and Portal Cavernomatosis

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular secondary prophylactic approach to gastroesophageal variceal (GOV) bleeding. However, standard primary prophylaxis is olten inef-fective and GOV bleeding is more severe than esophageal variceal (EV) bleeding. Portal vein thrombosis and its evolution to cavernomatosis are common complications of cirrhosis. There are no data in the literature on the safety of BRTO in patients with portal cavernomatosis and on the risk of excessively increasing portal hypertension in patients with esophageal varices at risk of bleeding. Portal cavernomatosis is a relative con-traindication to TIPS placement. Furthermore, in our knowledge there are no great experiences on the com-bined use of BRTO and TIPS and no information in patients with portal cavernomatosis.