{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:01:59Z","timestamp":1785391319018,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Treatment of acute gastric variceal bleeding (AGVB) in patients with large spontaneous portosystemic shunts (SPSS) remains challenging due to the severe, refractory nature of bleeding and the limitations of guideline-recommended therapies, which are associated with difficulty in achieving hemostasis, procedure-related complications, and resource-limited settings. This study aimed to explore the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO)-assisted endoscopic cyanoacrylate injection (ECI) as a potential therapy for AGVB with large SPSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center case series included adult patients (aged 18 or older) who underwent BRTO-assisted ECI for the treatment of AGVB with large SPSS (\u22651.2\u2005cm) from March 2022 to December 2024, with a 1-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 12 patients were enrolled (mean age 57.8 years; 83.3% male). Among them, 8 were classified as GOV2 and 4 as IGV1, with a median SPSS diameter of 1.6\u2005cm (IQR: 1.2\u20132.6). All cases of GVs (gastric varices) were attributed to liver cirrhosis, most commonly secondary to hepatitis B virus (58.3%). The majority of patients had Child-Pugh class B (50.0%) or C (41.7%). The clinical success rate was 91.6% (11\/12), and no symptomatic embolism or organ dysfunction was observed. There was no early rebleeding (0\/12), while the late rebleeding rate was 33.3% (4\/12) due to GVs recurrence without regular secondary prophylaxis of bleeding. Although no procedure-related deaths occurred, the 1-year mortality from all causes was 41.7%, primarily from progression of primary liver diseases and co-morbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BRTO-assisted ECI appears to be a potential therapy for treating AGVB with large SPSS, with high clinical success and no observed ectopic embolization. Larger prospective multicenter studies are needed to confirm these findings and evaluate long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1831070","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:41:17Z","timestamp":1785390077000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["BRTO-assisted endoscopic cyanoacrylate injection as a potential therapy for intractable acute gastric variceal bleeding with large SPSS: a retrospective single-center case series study"],"prefix":"10.3389","volume":"13","author":[{"given":"Kun","family":"He","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiming","family":"Xiao","sequence":"additional","affiliation":[{"name":"Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Li","sequence":"additional","affiliation":[{"name":"Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical 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