![]() In Europe, however, BRTO is not well recognized and not a treatment option for GVs. Since then, BRTO has been widely accepted in Japan, Asia, and the United States as an effective treatment for GVs. Balloon-occluded retrograde transvenous obliteration (BRTO), developed by Kanagawa in 1996, is a sclerotherapy technique that approaches the varices from the outflow side of the GRS. Eradication of GVs is difficult endoscopically because of the large diameter and high flow velocity of the shunts. ![]() In contrast, the short and posterior gastric veins comprise the main inflow of GVs, although the left gastric vein may also be involved the gastrorenal shunt (GRS), which drains blood to the left renal vein via the descending branch of the left inferior phrenic veins (80%–85%), and the gastrocaval shunt (GCS), which runs below the diaphragm and drains into the inferior vena cava (10%–15%) serve as outflow. The left and right gastric veins comprise the inflow of EVs, with the azygos vein system serving as the outflow. Hemodynamically, the two types of varices are completely different. Although the bleeding risk of GVs is relatively low, their rupture is associated with high mortality (14%–45%), because of their larger shunt diameter and higher flow. Gastric fundal varices (GVs) and esophageal varices (EVs) are two of the main presentations of cirrhosis-induced portal hypertension.
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