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25.04.2024 | Original Article

Is salvage Plug-Assisted Retrograde Transvenous Obliteration (PARTO) safe and effective for bleeding gastric varices ?- A preliminary single-center experience

verfasst von: Ranjan Kumar Patel, Taraprasad Tripathy, Manas Kumar Panigrahi, Hemant Kumar Nayak, Subash Chandra Samal, Bramhadatta Pattnaik, Tanmay Dutta, Sunita Gupta, Sudipta Mohakud, Suprava Naik, Nerbadyeswari Deep (Bag)

Erschienen in: Emergency Radiology | Ausgabe 3/2024

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Abstract

Background

Vascular plug-assisted retrograde transvenous obliteration (PARTO) obliterates the gastric varices and portosystemic shunt, thus resulting in a lower rebleeding rate than endoscopic glue/sclerotherapy.

Aims

To evaluate the safety and efficacy of PARTO as salvage therapy in liver cirrhosis with gastric variceal bleed (GVB) after failed endotherapy. We assessed the clinical success rate and changes in liver function at 6- months.

Materials and methods

Patients who underwent salvage PARTO after failed endotherapy for GVB (between December 2021 and November 2022) were searched and analyzed from the hospital database. Clinical success rate and rebleed rate were obtained at six months. Child–Pugh score (CTP) and Model for end-stage liver disease (MELD) score were calculated and compared between baseline and 6-month follow-up.

Results

Fourteen patients (n = 14, Child–Pugh class A/B) underwent salvage PARTO. Nine had GOV-2, and five had IGV-1 varices. The mean shunt diameter was 11.6 ± 1.6 mm. The clinical success rate of PARTO was 100% (no recurrent gastric variceal hemorrhage within six months). No significant deterioration in CTP (6.79 ± 0.98 vs. 6.21 ± 1.52; p = 0.12) and MELD scores (11.5 ± 4.05 vs. 10.21 ± 3.19; p = 0.36) was noted at 6 months. All patients were alive at 6 months. One patient (n = 1, 7.1%) bled from esophageal varices after three days of PARTO and was managed with variceal banding. 21.4% (3/14) patients had progression of esophageal varices at 6 months requiring prophylactic band ligation. Three patients (21.4%) had new onset or worsening ascites and responded to low-dose diuretics therapy.

Conclusions

PARTO is a safe and effective procedure for bleeding gastric varices without any deterioration in liver function even after six months. Patient selection is critical to prevent complications. Further prospective studies with larger sample size are required to validate our findings.

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Titel: Is salvage Plug-Assisted Retrograde Transvenous Obliteration (PARTO) safe and effective for bleeding gastric varices ?- A preliminary single-center experience
verfasst von: Ranjan Kumar Patel
Taraprasad Tripathy
Manas Kumar Panigrahi
Hemant Kumar Nayak
Subash Chandra Samal
Bramhadatta Pattnaik
Tanmay Dutta
Sunita Gupta
Sudipta Mohakud
Suprava Naik
Nerbadyeswari Deep (Bag)
Publikationsdatum: 25.04.2024
Verlag: Springer International Publishing
Erschienen in: Emergency Radiology / Ausgabe 3/2024
Print ISSN: 1070-3004
Elektronische ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-024-02232-2

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Is salvage Plug-Assisted Retrograde Transvenous Obliteration (PARTO) safe and effective for bleeding gastric varices ?- A preliminary single-center experience