Abstract：
OBJECTIVE: Balloon-occluded retrograde transvenous obliteration (BRTO) is widely performed for treating gastric varices (GVs). However, worsening of esophageal varices (EVs) can be observed after BRTO. This study aimed to investigate the impact of EV worsening on prognosis after BRTO.
METHODS: Overall, 258 patients who underwent initial BRTO for GV treatment between January 2004 and May 2019 at 12 institutions were retrospectively registered.
RESULTS: Technical success was achieved in 235 patients (91.1%). Based on the exclusion criteria, 37 patients were excluded, and 198 were evaluated. The cumulative worsening rates of EVs at 1, 2, and 3 years were 39.0%, 59.4%, and 68.4%, respectively. In the univariate Cox proportional hazards model, sex, EV size, history of EV treatment, left gastric vein dilatation, platelet count, aspartate transaminase (AST), alanine aminotransferase (ALT), total bilirubin, albumin, albumin-bilirubin score, prothrombin time-international normalized ratio, fibrosis-4 index, AST to platelet ratio index, and spleen width were significantly associated with worsening of EV after BRTO. Multivariate analysis showed that sex (adjusted hazard ratio [aHR] 1.72; 95% confidence interval [CI] 1.03-2.86; P = 0.04), left gastric vein dilatation (aHR 1.90; 95% CI 1.17-3.10; P = 0.01), ALT (aHR 1.01; 95% CI 1.00-1.03; P = 0.02), albumin (aHR 0.61; 95% CI 0.43-0.87; P < 0.01), and spleen width (aHR 1.02; 95% CI 1.01-1.03; P < 0.01) were independent risk factors for worsening of EV after BRTO. Patients with EV worsening within 1 year after BRTO had a significantly worse prognosis than the other patients (P = 0.007).
CONCLUSIONS: Early worsening of EV after BRTO was associated with poor prognosis after BRTO.
METHODS: Overall, 258 patients who underwent initial BRTO for GV treatment between January 2004 and May 2019 at 12 institutions were retrospectively registered.
RESULTS: Technical success was achieved in 235 patients (91.1%). Based on the exclusion criteria, 37 patients were excluded, and 198 were evaluated. The cumulative worsening rates of EVs at 1, 2, and 3 years were 39.0%, 59.4%, and 68.4%, respectively. In the univariate Cox proportional hazards model, sex, EV size, history of EV treatment, left gastric vein dilatation, platelet count, aspartate transaminase (AST), alanine aminotransferase (ALT), total bilirubin, albumin, albumin-bilirubin score, prothrombin time-international normalized ratio, fibrosis-4 index, AST to platelet ratio index, and spleen width were significantly associated with worsening of EV after BRTO. Multivariate analysis showed that sex (adjusted hazard ratio [aHR] 1.72; 95% confidence interval [CI] 1.03-2.86; P = 0.04), left gastric vein dilatation (aHR 1.90; 95% CI 1.17-3.10; P = 0.01), ALT (aHR 1.01; 95% CI 1.00-1.03; P = 0.02), albumin (aHR 0.61; 95% CI 0.43-0.87; P < 0.01), and spleen width (aHR 1.02; 95% CI 1.01-1.03; P < 0.01) were independent risk factors for worsening of EV after BRTO. Patients with EV worsening within 1 year after BRTO had a significantly worse prognosis than the other patients (P = 0.007).
CONCLUSIONS: Early worsening of EV after BRTO was associated with poor prognosis after BRTO.
摘要：
目的：球囊闭塞逆行静脉闭塞术（BRTO）广泛用于治疗胃静脉曲张（GVs）。然而,BRTO后可观察到食管静脉曲张（EV）恶化。本研究旨在探讨BRTO术后EV恶化对预后的影响。
方法：总的来说，回顾性登记了在2004年1月至2019年5月期间在12个机构接受GV初始BRTO治疗的258例患者。
结果：235例患者（91.1%）获得了技术成功。根据排除标准，37例患者被排除在外，对198人进行了评估。1年、2年和3年电动汽车的累积恶化率为39.0%，59.4%,和68.4%，分别。在单变量Cox比例风险模型中，性别,EV尺寸，EV治疗史，胃左静脉扩张,血小板计数,天冬氨酸转氨酶（AST），丙氨酸氨基转移酶（ALT），总胆红素,白蛋白,白蛋白-胆红素评分,凝血酶原时间-国际标准化比率，纤维化-4指数，AST与血小板比值指数,脾脏宽度与BRTO后EV恶化显著相关。多变量分析显示，性别(调整后的风险比[aHR]1.72;95%置信区间[CI]1.03-2.86;P=0.04)，胃左静脉扩张(aHR1.90;95%CI1.17-3.10;P=0.01),ALT（aHR1.01；95%CI1.00-1.03；P=0.02），白蛋白（AHR0.61；95%CI0.43-0.87；P<0.01），脾脏宽度（aHR1.02；95％CI1.01-1.03；P<0.01）是BRTO后EV恶化的独立危险因素。BRTO后1年内EV恶化的患者的预后明显比其他患者差（P=0.007）。
结论：BRTO术后早期EV恶化与BRTO术后不良预后相关。
方法：总的来说，回顾性登记了在2004年1月至2019年5月期间在12个机构接受GV初始BRTO治疗的258例患者。
结果：235例患者（91.1%）获得了技术成功。根据排除标准，37例患者被排除在外，对198人进行了评估。1年、2年和3年电动汽车的累积恶化率为39.0%，59.4%,和68.4%，分别。在单变量Cox比例风险模型中，性别,EV尺寸，EV治疗史，胃左静脉扩张,血小板计数,天冬氨酸转氨酶（AST），丙氨酸氨基转移酶（ALT），总胆红素,白蛋白,白蛋白-胆红素评分,凝血酶原时间-国际标准化比率，纤维化-4指数，AST与血小板比值指数,脾脏宽度与BRTO后EV恶化显著相关。多变量分析显示，性别(调整后的风险比[aHR]1.72;95%置信区间[CI]1.03-2.86;P=0.04)，胃左静脉扩张(aHR1.90;95%CI1.17-3.10;P=0.01),ALT（aHR1.01；95%CI1.00-1.03；P=0.02），白蛋白（AHR0.61；95%CI0.43-0.87；P<0.01），脾脏宽度（aHR1.02；95％CI1.01-1.03；P<0.01）是BRTO后EV恶化的独立危险因素。BRTO后1年内EV恶化的患者的预后明显比其他患者差（P=0.007）。
结论：BRTO术后早期EV恶化与BRTO术后不良预后相关。
