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Accelerated balloon-retrograde transvenous obliteration (BRTO): an effective tool in the Arsenal against isolated gastric varices (IGV)
  1. Smit Sunil Deliwala1,
  2. Murtaza Hussain1,
  3. Anoosha Ponnapalli1,
  4. Samuel O Igbinedion2,
  5. Ghassan Bachuwa1 and
  6. Anish Bansal3
  1. 1Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
  2. 2Division of Gastroenterology & Hepatology, Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
  3. 3Department of Interventional Radiology, Michigan State University at Hurley Medical Center, Flint, Michigan, USA
  1. Correspondence to Dr Ghassan Bachuwa; gbachuw2{at}


Gastric and oesophageal variceal bleeding poses high morbidity and mortality in cirrhosis. Amongst all types, isolated gastric varices (IGV) carry the highest propensity to bleed. Successful outcomes combine endoscopic and interventional radiology approaches using ligation, coils, glue or sclerosants. Transjugular intrahepatic portosystemic shunt success is only seen in a subset of patients, while balloon-retrograde transvenous obliteration (BRTO) has demonstrated high efficacy in preventing rebleeding and morbidity in patients with a myriad of anatomies and shunts. The American Association for the Study of Liver disease guidelines do not favour any particular modality; however, recent trials and meta-analyses support BRTO as the first-line therapy. Despite promising results, BRTO adoption is limited by procedural time, patient length-of-stay and equipment compatibilities hindering scalability in academic and community settings. To address these concerns, we present a successfully treated case of IGV with a revised technique called accelerated BRTO.

  • gastroenterology
  • stomach and duodenum
  • portal hypertension

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  • Contributors SSD was responsible for conception, drafting and review. MH and AP were involved in drafting and acquisition. SI was responsible for interpretation and review. AB helped in drafting, acquisition, interpretation and review. GB helped in review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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