Corrigendum to “Balloon-occluded retrograde transvenous obliteration: it is time to jump on the bandwagon”

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The Author regrets that in the above Letter to the Editor an error occurred in line 16 of the Letter. It should have read ‘PPG≤12 mmHg’. The correct paragraph is printed below.

We recently read with interest the article by Bosch et al. on current management of portal hypertension [1]. It has been reported that esophageal varices rarely bleed if the portal pressure gradient (PPG)<12 mmHg [1]. However, the hemodynamics of gastric varices, especially isolated fundal varices (FV), are very different from those of esophageal varices. Because most FV are associated with a developed gastrorenal shunt, portal venous pressure of patients with large FV is quite low, whereas collateral flow into the FV is abundant [2]. Transjugular intrahepatic portosystemic shunt (TIPS) is the current standard therapy for bleeding esophagogastric varices unresponsive to pharmacological and endoscopic treatment [1]. In contrast, Tripathi and colleagues showed that gastric variceal bleeding was likely to occur at a PPG≤12 mmHg, and that TIPS only improved the mortality of patients with gastric variceal bleeding at a PPG>12 mmHg [3]. Therefore, decompressive therapy such as TIPS or pharmacological treatment seems to be ineffective for FV associated with a gastrorenal shunt. Thus, obliteration of FV in a safe manner could be justifiable. Cyanoacrylate has been shown to be effective for control of acute bleeding from FV [1], but the rebleeding rate is relatively high [4]. Further, value of cyanoacrylate in large (>12 mm) FV without active bleeding is controversial due to the potential for systemic complications caused by the migration of cyanoacrylate into the inferior vena cava through a gastrorenal shunt [5].