Effectiveness of Retrograde Transvenous Obliteration for Primary Prophylaxis of Gastric Variceal Bleeding.

Background: Retrograde transvenous obliteration is an endovascular interventional radiology procedure demonstrating safety and efficacy for secondary prophylaxis in high-risk gastric varices. However, its efficacy as primary prophylaxis is uncertain. We conducted a systematic review and case series to evaluate the utility of this technique.

Methods: A literature search utilized EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. Inclusion criteria involved single technique obliteration, known varices, and exclusively primary prophylaxis. The primary outcome was gastric variceal bleeding, with secondary outcomes of technical success, variceal eradication, adverse events, and mortality. A retrospective case series of nine patients who underwent primary prophylaxis at our North American centre was also conducted.

Results: Of the 842 articles retrieved, 69 were eligible for full-text review, with the 9 studies included in the final analysis involving balloon-occluded, but not plug-assisted or coil-assisted, techniques. Only 2/9 studies involved comparator groups, with a single prospective non-randomized trial, and there was a high risk of bias in 8/9 studies. The technical success rate of the balloon-occluded obliteration technique ranged from 82% to 100%, and the variceal eradication rate ranged from 88% to 100%. In comparative studies, patients had decreased variceal bleeding and bleeding-related mortality compared with control cohorts. Our case series demonstrated a 78% survival rate with no variceal bleeding. Post-procedure ascites and worsening esophageal varices ranged from 0-55% to 11-80%, respectively.

Conclusion: This review summarizes evidence regarding the efficacy of retrograde transvenous obliteration, with available studies demonstrating a high success rate in eradicating varices and preventing bleeding-associated mortality, albeit with concerns of overall quality of existing literature.