ArticleFrontiers in surgery2026
BRTO-assisted endoscopic cyanoacrylate injection as a potential therapy for intractable acute gastric variceal bleeding with large SPSS: a retrospective single-center case series study.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims: Treatment of acute gastric variceal bleeding (AGVB) in patients with large spontaneous portosystemic shunts (SPSS) remains challenging due to the severe, refractory nature of bleeding and the limitations of guideline-recommended therapies, which are associated with difficulty in achieving hemostasis, procedure-related complications, and resource-limited settings. This study aimed to explore the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO)-assisted endoscopic cyanoacrylate injection (ECI) as a potential therapy for AGVB with large SPSS. Methods: This retrospective single-center case series included adult patients (aged 18 or older) who underwent BRTO-assisted ECI for the treatment of AGVB with large SPSS (≥1.2 cm) from March 2022 to December 2024, with a 1-year follow-up. Results: A total of 12 patients were enrolled (mean age 57.8 years; 83.3% male). Among them, 8 were classified as GOV2 and 4 as IGV1, with a median SPSS diameter of 1.6 cm (IQR: 1.2-2.6). All cases of GVs (gastric varices) were attributed to liver cirrhosis, most commonly secondary to hepatitis B virus (58.3%). The majority of patients had Child-Pugh class B (50.0%) or C (41.7%). The clinical success rate was 91.6% (11/12), and no symptomatic embolism or organ dysfunction was observed. There was no early rebleeding (0/12), while the late rebleeding rate was 33.3% (4/12) due to GVs recurrence without regular secondary prophylaxis of bleeding. Although no procedure-related deaths occurred, the 1-year mortality from all causes was 41.7%, primarily from progression of primary liver diseases and co-morbidities. Conclusion: BRTO-assisted ECI appears to be a potential therapy for treating AGVB with large SPSS, with high clinical success and no observed ectopic embolization. Larger prospective multicenter studies are needed to confirm these findings and evaluate long-term outcomes.
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