Plug-Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Variceal Bleeding in Left-Sided Portal Hypertension: An Institutional Case Series.

Abstract

Purpose: This case series aims to evaluate the procedural safety and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) in patients presenting with severe upper gastrointestinal bleed secondary to left sided portal hypertension (LSPH) following unsuccessful conservative and endoscopic management.

Material and Methods: The study includes 4 patients presenting with acute upper gastrointestinal bleed and LSPH. Pre-procedural imaging workup was performed to confirm the presence of gastro-renal shunt and rule out high-risk anatomical factors. After failure of endoscopic management, PARTO was performed with subsequent gel-foam embolization of the gastric varices. Post-procedural outcomes were noted at 1 month and 3 months.

Results: All four patients showed significant clinical improvement post procedure with no recurrent bleeding. On 1 month and 3 months follow up, one patient experienced progression in ascites and another patient progression in esophageal varices requiring endoscopic banding at 2 months. All patients had reduction in size of gastric varices at 3 months follow up endoscopy. Overall PARTO demonstrated high clinical success rate with minimal complications. 

Conclusions: PARTO has emerged as a safe and promising solution treating gastro-variceal bleed secondary to left-sided portal hypertension and gastro-renal shunt draining anatomy, particularly after failed endoscopic management. The technique has high clinical success rate, good short term clinical outcome and associated with minimal complications.