Balloon-occluded Retrograde Transvenous Obliteration Treats Hepatic Dysfunction and Gastric Varices

Abstract

The survival rate of patients with biliary atresia has been increasing since the introduction of Kasai (hepatic) portoenterostomy (1); however, because it is an auxiliary treatment unable to solve the progressive cholangiopathy, mortality and rates of complications, such as variceal bleeding, remain high. Miscellaneous modalities including endoscopy, intervention, and surgery have been introduced to treat variceal bleeding. Balloon-occluded retrograde transvenous obliteration (B-RTO) is now widely performed to treat gastric varices, and several reports have described the effectiveness of B-RTO in adults (2). Moreover, the hemodynamic alternations after B-RTO may improve hepatic function by resolving the problem of hepatic insufficiency (3). Children with biliary atresia have less severe hepatic dysfunction than adults with end-stage liver disease and are thus likely to show a better result, after B-RTO. However, there is no case report on the correlation between hepatic function and B-RTO in children. We report a case of successfully performed B-RTO in a 9-year-old girl with gastric variceal bleeding after a Kasai operation and its positive influence on hepatic function.