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

Abstract

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.

Keywords: Balloon-occluded transvenous obliteration; Gastric devascularization; Gastric varices; Portal hypertension; Splenectomy.

Fig. 1

Flowchart of patient population selection: 108 patients undergoing Sp + Dev or BRTO for gastric varices recruited. After excluding 8 patients, 100 patients were included for statistical analysis. Sp + Dev splenectomy and gastric devascularization, BRTO balloon-occluded retrograde transvenous obliteration, IVR interventional radiology

Fig. 2

a Overall survival (OS) in the Sp + Dev and BRTO group in all patients. Note the significantly lower OS following Sp + Dev compared to BRTO (p = 0.005). b OS in the Sp + Dev and BRTO groups after IPTW adjustment. Note a significantly lower OS after Sp + Dev compared to the BRTO groups (p = 0.048). Sp + Dev splenectomy and gastric devascularization, BRTO balloon-occluded retrograde transvenous obliteration, IPTW inverse probability of a treatment weighting

Fig. 3

a The incidence rate of rebleeding in the Sp + Dev and BRTO groups. No significant difference was found between the two groups (p = 0.124). b The incidence rate of rebleeding in the Sp + Dev and BRTO groups after IPTW adjustment. No significant difference was found between the two groups (p = 0.620). Sp + Dev splenectomy and gastric devascularization, BRTO balloon-occluded retrograde transvenous obliteration, IPTW inverse probability of a treatment weighting

Fig. 4

Dynamics of liver function after Sp + Dev (n = 45) and BRTO (n = 55) assessed by paired t test: changes in a PT%, b albumin, c total bilirubin, d Child–Pugh score, and e platelet counts differed by procedure over time. Variables expressed as the mean ± 95% confidence interval. Sp + Dev splenectomy and gastric devascularization, BRTO balloon-occluded transvenous obliteration, PT% prothrombin time% activity. *p < 0.050