Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiff measurement predict the prognosis of the patients with gastric varices

Abstract

Abstract Background Balloon-occluded retrograde transvenous obliteration (B-RTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbation of esophageal varices (EVs), and prognosis of patients who underwent B-RTO for GVs. Methods Thirty-six patients with GVs treated with B-RTO were enrolled in this study, and their HVPG was measured before (pre-HVPG) and on the day after B-RTO (post-HVPG). After B-RTO, patients were followed-up for median 24.5 (3–140) months. Clinical factors related to EV exacerbation and prognosis after B-RTO were retrospectively analyzed. Results Post-HVPG increased from pre-HVPG in 21 out of 36 patients (58%), and overall post-HVPG was significant higher compared to pre-HVPG (P = 0.009). During the observation period, EV exacerbation was developed in 19 patients (53%), and the cumulative EV exacerbation rates at 1, 3, and 5 years after B-RTO were 27%, 67%, and 73%, respectively. Pre-HVPG was not correlated to EV exacerbation, but elevated post-HVPG of ≥ 13 mmHg (P < 0.01) and high level of serum aspartate aminotransferase (P < 0.05) were significant independent risk factors for EV exacerbation after B-RTO. Fourteen patients (38.9%) died during the observation period. Elevated liver stiffness measurement (LSM) of ≥ 21 kPa was the significant independent risk factor for poor prognosis after B-RTO (P < 0.05). Conclusions HVPG increases after B-RTO. HVPG after B-RTO predicts subsequent EV exacerbations more perceptively than HVPG before B-RTO. LSM is a potential prognostic parameter for patients who underwent B-RTO.