Balloon-occluded retrograde transvenous occlusion.

The current article describes a patient with acute, massive upper gastrointestinal bleeding from isolated gastric varices. The patient had a large gastrosystemic shunt and was managed with a combination of splenic artery embolization followed by balloon-occluded retrograde transvenous occlusion (BORTO) of the gastric varices. BORTO is a procedure that was recently described in Japan by Dr Kanagawa. This technique is extensively used in Japan as first-line therapy in the management of bleeding gastric varices but has not been popularized in the USA. The purpose of this review is to present the technique used to perform BORTO at our institution and the clinical situations in which we offer this option to our patients.