Transhepatic Antegrade Gastric Variceal Sclerotherapy: Comparing Outcomes with and without Initial Efferent Vein Embolization

Purpose

To compare the effectiveness of percutaneous transhepatic obliteration (PTO) with initial afferent vein embolization (PTO-A) and with initial efferent vein embolization (PTO-E) for gastric varices (GVs).

Materials and Methods

Consecutive patients undergoing PTO-A or PTO-E for type 1 isolated GVs or type 2 gastroesophageal varices between June 2007 and February 2023 were included. PTO-A or PTO-E was indicated when balloon-occluded retrograde transvenous obliteration failed or there was no portosystemic shunt for the retrograde transvenous approach. PTO-A was performed for patients before March 2009 and for patients with multiple efferent channels from the GVs. PTO-E was attempted for patients after April 2009. Twenty-six patients were included, of whom 18 underwent PTO-A and 8 underwent PTO-E. In 12 patients, PTO-E was attempted without success, and they underwent PTO-A instead. The primary outcome was successful complete eradication of GVs within 1 week after the procedure. The secondary outcomes were the GV recurrence-free period and overall survival after the procedure.

Results

Technical success was achieved in all 26 patients, with complete GV eradication rates of 33.3% in PTO-A and 100% in PTO-E, significantly higher in PTO-E (P = .002). The median recurrence-free periods were 8.7 months with PTO-A and 75.1 months with PTO-E; PTO-E had a significantly longer recurrence-free period (P = .042). The median overall survival durations were 37.2 months with PTO-A and 49.9 months with PTO-E, with no significant difference (P = .955).

Conclusions

PTO-E had a better complete eradication rate and longer recurrence-free period than PTO-A for GVs.