Gelatin Sponge without Sclerosant During Plug-Assisted Retrograde Obliteration for Gastric Varices: A Single Center Retrospective Study

Abstract The aim of the study is to evaluate the safety and effectiveness of using gelatin sponge without sclerosant during plug-assisted retrograde transvenous obliteration (PARTO) for variceal hemorrhage. This is an institutional review board-approved retrospective analysis of 45 consecutive patients (34 men, 11 women; mean age, 45 years; range 16–70 years) who underwent RTO between 2019 and 2025 for gastric variceal hemorrhage. The procedure involved the use of vascular plugs in conjunction with absorbable gelatin sponge without the addition of sclerosants. Clinical and laboratory data were reviewed to assess procedural outcomes, including technical and clinical success rates, as well as associated complications. Patients were followed for a median of 3 years (range 3–5 years). Technical success—defined as occlusion of the gastrorenal shunt and complete opacification of the gastric varix with gelatin sponge slurry—was achieved in all 45 patients (100%). Clinical success, defined as the absence of upper gastrointestinal bleeding during the follow-up period, was observed in all patients. Follow-up CT obtained within 1 week after RTO showed complete thrombosis of gastric varices and portosystemic shunts in all patients (100%). Death due to other causes occurred in five patients. Among the five patients who died during follow-up, the median time to death was 18 months. There were no immediate procedure-related complications. During the follow-up period, all patients demonstrated sustained clinical success, with a median follow-up duration of 3 years. No cases of upper gastrointestinal bleeding or hepatic encephalopathy were observed throughout the follow-up period. The use of gelatin sponge without sclerosant during PARTO is safe and effective for the management of gastric variceal hemorrhage, with durable long-term outcomes.