Double-balloon (CANDIS) Retrograde Transvenous Obliteration Improves Hepatic Functional Reserve Compared with the Conventional Method

Purpose: Conventional balloon-occluded retrograde transvenous obliteration often fails to achieve complete occlusion in cases with complex collateral drainage, leading to variable outcomes. The cooperative anti-reflux and double interruption system, a coaxial dual-balloon device, was developed to achieve more stable venous occlusion. This study aimed to evaluate the clinical and hepatic functional benefits of double-balloon balloon-occluded retrograde transvenous obliteration compared with the conventional single-balloon method for gastric varices. Material and Methods: This single-center retrospective study included 48 patients with gastric varices who underwent balloon-occluded retrograde transvenous obliteration between February 2008 and March 2020. Eighteen patients received the single-balloon method, and 30 underwent the double-balloon procedure. Clinical and technical success rates, complications, and hepatic function parameters (Child-Pugh and albumin-bilirubin scores) were compared up to 12 months after balloon-occluded retrograde transvenous obliteration. Results: The clinical success rate was significantly higher with cooperative anti-reflux and double interruption system than with the single-balloon method (90.0% vs. 50.0%, p = 0.004), whereas technical success rates were high in both groups (100% vs. 88.9%). In the cooperative anti-reflux and double interruption system group, hepatic functional reserve improved markedly, with significant decreases in albumin-bilirubin (Δalbumin-bilirubin: -0.283 vs. +0.001, p < 0.05) and Child-Pugh scores (ΔChild-Pugh: -0.19 vs. +1.09, p < 0.05) during 5-12 months of follow-up. Complication rates were comparable between groups. Conclusions: Double-balloon balloon-occluded retrograde transvenous obliteration using the cooperative anti-reflux and double interruption system significantly improves clinical success and long-term hepatic function compared with the conventional method, providing a safe and effective treatment for gastric varices. This dual-balloon approach ensures stable occlusion and uniform sclerosant distribution even in cases with complex collateral drainage, leading to more reliable treatment outcomes and enhanced hepatic functional recovery.