OBJECTIVES: Although balloon-occluded retrograde transvenous obliteration (B-RTO) is useful for management
of gastric varices, worsening of esophageal varices (EV) is the most important complication of
B-RTO. The predictive factors of worsening of EV have not been evaluated in detail. This study
was designed to evaluate the role of endoscopic color Doppler ultrasonography (ECDUS) in the
detection of possible risk factors for worsening of EV after B-RTO.
METHODS: A total of 39 cirrhotic patients with high-risk gastric varices successfully treated by B-RTO were
included in this study. All patients underwent ECDUS before B-RTO to measure hemodynamic
parameters of gastric varices and regular endoscopic follow-up after B-RTO to detect worsening of
EV. The risk factors were analyzed by Cox ’ s proportional hazards regression.
RESULTS: Worsening of EV was found in 24 (61.5 % ) patients. The presence of esophageal varices before
B-RTO and a lower degree of liver dysfunction (Child-Pugh class B) were statistically independent
risk factors for worsening of EV after B-RTO (hazard ratio, HR, 5.81, 95 % confi dence interval,
CI, 1.71 – 19.77 and HR 2.92, 95 % CI: 1.21 – 7, respectively). High resistance index ( ≥ 0.24),
measured by ECDUS, is also an independent risk factor for worsening of EV after B-RTO (HR
4.06, 95 % CI: 1.14 – 14.38) and increase in resistance index is associated with worsening of EV
( P for trend = 0.028).
CONCLUSIONS: The presence of EV, higher Child-Pugh class, and higher resistance index assessed by ECDUS
before B-RTO were signifi cant risk factors for worsening of EV after B-RTO.