Abstract：
BACKGROUND: Balloon-occluded retrograde transvenous obliteration (BRTO) was developed as an effective treatment for gastric varices in patients with cirrhosis. Because liver fibrosis in these patients is assumed to be advanced, their prognosis is expected to be poor. In this study, we investigated the prognosis and characteristics of the patients.
METHODS: We enrolled 55 consecutive patients with liver cirrhosis treated with BRTO between 2009 and 2021 at our department. To evaluate factors related to variceal recurrence and long-term prognosis, survival analysis was performed on 45 patients, excluding those who died within 1 month, had an unknown prognosis, or whose treatments were converted to other treatments.
RESULTS: During a mean follow-up period of 2.3 years, esophageal varices recurred in 10 patients and could be treated endoscopically. Non-alcoholic steatohepatitis (NASH) was related to the variceal recurrence (hazard ratio [HR] = 4.27, 95% CI: 1.17-15.5, p = 0.028). The survival rate after the procedure at 1, 3, and 5 years was 94.2%, 74.0%, and 63.5%, respectively, and 10 patients died of hepatocellular carcinoma (n = 6), liver failure (n = 1), sepsis (n = 1), and unknown reasons (n = 2). The estimated glomerular filtration rate (eGFR) level was proved to be a significant poor prognostic factor (HR = 0.96, 95% CI: 0.93-0.99, p = 0.023). The comorbid hypertension (HTN) was the main cause of low eGFR, and HTN was also significantly related to survival (HR = 6.18, 95% CI: 1.57-24.3, p = 0.009). Most of the patients with HTN were treated with calcium channel blocker and/or angiotensin receptor blocker.
CONCLUSIONS: The clinical course of patients with cirrhosis treated with BRTO was dependent on the metabolic factors including renal function, comorbid HTN, and NASH.
METHODS: We enrolled 55 consecutive patients with liver cirrhosis treated with BRTO between 2009 and 2021 at our department. To evaluate factors related to variceal recurrence and long-term prognosis, survival analysis was performed on 45 patients, excluding those who died within 1 month, had an unknown prognosis, or whose treatments were converted to other treatments.
RESULTS: During a mean follow-up period of 2.3 years, esophageal varices recurred in 10 patients and could be treated endoscopically. Non-alcoholic steatohepatitis (NASH) was related to the variceal recurrence (hazard ratio [HR] = 4.27, 95% CI: 1.17-15.5, p = 0.028). The survival rate after the procedure at 1, 3, and 5 years was 94.2%, 74.0%, and 63.5%, respectively, and 10 patients died of hepatocellular carcinoma (n = 6), liver failure (n = 1), sepsis (n = 1), and unknown reasons (n = 2). The estimated glomerular filtration rate (eGFR) level was proved to be a significant poor prognostic factor (HR = 0.96, 95% CI: 0.93-0.99, p = 0.023). The comorbid hypertension (HTN) was the main cause of low eGFR, and HTN was also significantly related to survival (HR = 6.18, 95% CI: 1.57-24.3, p = 0.009). Most of the patients with HTN were treated with calcium channel blocker and/or angiotensin receptor blocker.
CONCLUSIONS: The clinical course of patients with cirrhosis treated with BRTO was dependent on the metabolic factors including renal function, comorbid HTN, and NASH.
摘要：
背景：球囊闭塞逆行静脉闭塞（BRTO）被开发为肝硬化患者胃静脉曲张的有效治疗方法。因为这些患者的肝纤维化被认为是晚期的，他们的预后预计较差。在这项研究中,我们调查了患者的预后和特征。
方法：我们招募了2009年至2021年间接受BRTO治疗的55例肝硬化患者。评估静脉曲张复发和长期预后的相关因素。对45例患者进行生存分析，不包括在1个月内死亡的人，预后不明,或其治疗转化为其他治疗。
结果：在平均2.3年的随访期间，10例患者食管静脉曲张复发，可以通过内镜治疗。非酒精性脂肪性肝炎（NASH）与静脉曲张复发有关（风险比[HR]=4.27，95％CI：1.17-15.5，p=0.028）。术后1、3、5年生存率为94.2%,74.0%,63.5%,分别,10例患者死于肝细胞癌（n=6），肝功能衰竭（n=1），脓毒症（n=1），未知原因（n=2）。估计的肾小球滤过率（eGFR）水平被证明是显着的不良预后因素（HR=0.96，95％CI：0.93-0.99，p=0.023）。合并症高血压（HTN）是eGFR低的主要原因，和HTN也与生存率显着相关（HR=6.18，95％CI：1.57-24.3，p=0.009）。大多数HTN患者接受钙通道阻滞剂和/或血管紧张素受体阻滞剂治疗。
结论：BRTO治疗肝硬化患者的临床病程取决于包括肾功能在内的代谢因素，HTN合并症，和NASH。
方法：我们招募了2009年至2021年间接受BRTO治疗的55例肝硬化患者。评估静脉曲张复发和长期预后的相关因素。对45例患者进行生存分析，不包括在1个月内死亡的人，预后不明,或其治疗转化为其他治疗。
结果：在平均2.3年的随访期间，10例患者食管静脉曲张复发，可以通过内镜治疗。非酒精性脂肪性肝炎（NASH）与静脉曲张复发有关（风险比[HR]=4.27，95％CI：1.17-15.5，p=0.028）。术后1、3、5年生存率为94.2%,74.0%,63.5%,分别,10例患者死于肝细胞癌（n=6），肝功能衰竭（n=1），脓毒症（n=1），未知原因（n=2）。估计的肾小球滤过率（eGFR）水平被证明是显着的不良预后因素（HR=0.96，95％CI：0.93-0.99，p=0.023）。合并症高血压（HTN）是eGFR低的主要原因，和HTN也与生存率显着相关（HR=6.18，95％CI：1.57-24.3，p=0.009）。大多数HTN患者接受钙通道阻滞剂和/或血管紧张素受体阻滞剂治疗。
结论：BRTO治疗肝硬化患者的临床病程取决于包括肾功能在内的代谢因素，HTN合并症，和NASH。
