Plug-assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varices: Long-term Outcomes of Primary and Secondary Prophylaxis

Purpose: To evaluate the long-term outcomes of plug-assisted retrograde transvenous obliteration (PARTO) for the treatment of gastric varices (GVs).

Materials and Methods: This retrospective study included 220 patients treated with PARTO between February 2011 and December 2022. PARTO was performed for secondary prophylaxis (SP) in 81 patients with recent gastric variceal bleeding and for primary prophylaxis (PP) in 139 patients with large (≥2 cm), growing GVs, or planned anticoagulation. The efficacy of PARTO and potential trade-offs, such as worsening of esophageal varices (EVs) and ascites, were analyzed.

Results: The technical success rate of PARTO was 94.5% (208/220). Severe adverse events occurred in two (0.9%) patients. The median procedure time was 22 minutes (range, 8–121 minutes). Long-term follow-up data were available for 177 patients (PP, n=119 and SP, n=58), with a mean follow-up of 42.5 months (maximum, 154.6 months). All 177 showed thrombosed or obliterated GVs. Ten (5.6%) patients showed recurrence of GVs different to that treated with PARTO), occurring at a median time of 14.4 months. The presence of combined type 1 and type 2 gastroesophageal varices was an independent predictive factor for recurrence of GVs (p=0.004). The cumulative 1-, 3-, 5-, and 10-year freedom from GV recurrence rates were 97.3%, 94.1%, 92.2%, and 85.1%, respectively. EV exacerbation was observed in 59 patients (33.3%).

Conclusion: PARTO is effective for GV treatment and may serve as a first-line option for both PP and SP in selected patients. However, due to potential EV worsening, close endoscopic monitoring is essential.