Analysis of Life Burden on Patients with Gastric Varices Treated with TIPS versus BRTO/BATO

Monday, March 31, 2025

3:18 PM – 3:27 PM CT

Location: Music City Center, 204

Presenting Author(s)

Abdifatah Omar

Medical Student
Warren Alpert Medical School of Brown University, Providence, RI 02901, United States

Author/Co-author(s)

JA

Jacob Abraham, BS

Medical Student
Warren Alpert Medical School of Brown University, Providence, RI 02901, United States
MB

Michelle Bae, BS

Medical Student
Warren Alpert Medical School of Brown University, Providence, RI 02901, United States
Jessica Yoon, MD, MBA (she/her/hers)

Resident
Brown University / Rhode Island Hospital, United States
AM

Aaron WP Maxwell, MD

Director of Vascular and Interventional Oncology
Alpert Medical School, Brown University, United States
JL

John Lee, MD

Attending
Brown University / Rhode Island Hospital, United States
DK

Daehee Kim, MD

Assistant Professor
Rhode Island Hospital; Alpert Medical School Brown University, United States

Purpose: To assess the impact on quality of life days between patients undergoing TIPS (Transjugular intrahepatic portosystemic shunt) and BRTO/BATO (Balloon-occluded retrograde transvenous obliteration/Balloon-occluded antegrade transvenous obliteration) for gastric varices.

Materials and Methods:
A total of 117 patients were included, with 59 undergoing TIPS only, 28 undergoing TIPS and variceal embolization (TIPS/VE), and 30 undergoing BRTO/BATO alone, at a tertiary medical center between January 2003 and December 2023. Retrospective chart review was conducted to evaluate hospitalization frequency and duration, as well as clinical outcomes including complications rates, rebleeding, and survival.

Results: The median post-procedural follow-up period was 1068 days. Preprocedural MELD scores exhibited a statistical difference between the three cohorts, (BRTO/BATO, 20.5±7.1, TIPS, 16.5±6.2, and TIPS/VE, 17.2±7.34, p=0.042) with the highest scores in BRTO/BATO, indicative of more severe liver disease. There was a significant difference in the average number of days hospitalized among the cohorts (BRTO/BATO: 14.8 ± 18.5, TIPS: 34.7 ± 40.9, TIPS/VE: 25.5 ± 25.8, p=0.017), with the shortest stays observed in the BRTO/BATO group. Similarly, we found significant difference in intensive care unit (ICU) stays with shortest stays in the BRTO/BATO alone group (BRTO/BATO: 4.8 ± 4.5, TIPS: 8.6 ± 10.4, TIPS/VE: 7.6 ± 6.5, p=0.049). All three groups exhibited similar survival and rebleeding rates.

Conclusion: Despite their worse baseline liver function, patients who underwent BRTO/BATO alone seem to experience longer periods outside of the hospital when compared to both TIPS and TIPS/VE patients. Our results suggest a potential quality of life benefit and decrease in healthcare utilization in patients with gastric varices treated with BRTO/BATO compared to TIPS.