الفهرس 
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Abstract
The purpose of this study is to evaluate the role of balloon-occluded retrograde transvenous obliteration (BRTO) of the gastric varices. Twenty patients (15 males and 5 females), their age ranged from 42 to 65 years with the mean age 53.5 years. with confirmed portal hypertension by laboratory and radiological findings. All patients had portal hypertension, gastric varices, hepatic encephalopathy or both. Patients were referred to radiology department in the specialized medical hospital, Mansuora university from Hepatology and gastroenterology outpatient clinic. All patients were subjected to history taking and full clinical examination. Ultrasound examination, and spiral C.T. scan were done for all patients. Also, fibro-optic upper GIT endoscope was done for all patients before and after BRTO. The balloon-occluded retrograde transvenous obliteration procedure was done for 20 patients included in the current study, 14 patients with GV, 3 patients with hepatic encephalopathy and 3 patients with both GV and hepatic encephalopathy. The GRS and collaterals were evaluated by the pre-procedure CT. The technique was successful in 17 patients (12 with GV , 3 with hepatic encephalopathy and 2 patients with both GV and hepatic encephalopathy). The catheter failed to be inserted into the shunt in one patient either through trans-femoral or trans-jugular approach. The other 2 cases, the shunt was very large and the balloon could not occlude the shunt and could not be distally impacted into a narrow segment. The 17 patients with succeeded B-RTO technique were followed up by CT and upper GIT endoscope after 1 and 3 months. The CT findings revealed complete occlusion of the GRS in all cases and eradication of the gastric varices. While endoscopic findings shows complete disappearance of the gastric varices within 3 months. In fact, in the current study, 5 patients experienced exacerbation of their esophageal varices after balloon-occluded retrograde transvenous obliteration. However, these esophageal varices could be largely controlled with endoscopic injection sclerotherapy. In conclusion, balloon-occluded retrograde transvenous obliteration is a minimally less invasive technique that effectively causes the gastric fundal varices to coagulate because of stoppage of the voluminous blood flow in the varices by retrograde balloon occlusion. It shows a high rate of hemostasis and a low rate of rebleeding for patients who have gastric varices in danger of rupture and in association with a gastrorenal shunt beside improving portosystemic encephalopathy or both.