Balloon-occluded retrograde transvenous obliteration for treatment of portal hypertensive related varices

Purpose of reviewBalloon-occluded retrograde transvenous obliteration (BRTO) is becoming a more commonly used procedure to manage various complications of liver disease. It is important to understand the technique of the procedure, the indications for its use, and also potential associated complications.Recent findingsBRTO is superior to endoscopic cyanoacrylate injection and transjugular intrahepatic portosystemic shunt for bleeding gastric varices associated with a portosystemic shunt and should be considered a first line therapy in these patients. In addition, it has been shown to be useful in controlling ectopic variceal bleeding, improving portosystemic encephalopathy, and also in modulating blood flow in the post liver transplant setting. Modified versions of BRTO, plug assisted retrograde transvenous obliteration and coil assisted retrograde transvenous obliteration, have been developed to reduce procedure time and improve complication rates.As the use of BRTO expands in clinical practice it will be important for gastroenterologists and hepatologists to better understand the procedure. There are still many research questions left to answer regarding the use of BRTO in specific situations and for specific patient populations.

Automated summary

This article discusses the use, technique, and potential complications of balloon-occluded retrograde transvenous obliteration (BRTO) for managing complications of liver disease. Research findings suggest that BRTO is superior to other treatments for bleeding gastric varices associated with a portosystemic shunt, and it has shown positive outcomes in controlling ectopic variceal bleeding, improving portosystemic encephalopathy, and modulating blood flow in the post liver transplant setting. Modified versions of BRTO have been developed to improve procedure time and complication rates. Further research is needed to explore the use of BRTO in specific situations and patient populations.