BRTO: Past, Present, and Future Directions

Balloon-occluded retrograde transvenous obliteration (BRTO) has been developed in Japan as a treatment for gastric varices (GV). The technique has spread mainly around Asia, but is now gaining wider recognition in the United States and Europe. BRTO is characterized by high therapeutic efficacy against GV, and a recent study demonstrated that BRTO resulted in improved liver function after the procedure. In addition, BRTO is becoming an effective treatment for the recently proposed concept of "portosystemic shunt syndrome". In this review, we describe the indications, methods, and modifications of BRTO, and also discuss the indications and current status of BRTO for portosystemic shunt syndrome.