Plug-assisted Retrograde Transvenous Obliteration with or without Partial Splenic Embolisation for Gastric Variceal Bleeding: A Retrospective Study

Introduction: Gastric variceal bleeding is a severe complication of portal hypertension with limited efficacy of endoscopic therapy in patients with large fundal varices or spontaneous shunts. Plug-Assisted Retrograde Transvenous Obliteration (PARTO) offers a minimally invasive alternative by occluding the Gastro-renal Shunt (GRS) and achieving durable variceal control. Partial Splenic Embolisation (PSE) may further lower portal pressure and improve hypersplenism. Aim: To compare outcomes between PARTO alone and PARTO with PSE, in terms of variceal regression, Oesophageal Varices (EV) progression, and complication rates. Materials and Methods: A retrospective observational study was conducted in the Department of Interventional Radiology at Dr. D Y Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, from May 2023 to May 2025. The study included 20 patients with gastric variceal bleeding secondary to portal hypertension who underwent PARTO or PARTO + PSE after resistant to or failed endoscopic management. Group A (n=15) underwent PARTO alone, and Group B (n=5) underwent PARTO with adjunctive PSE. Technical and clinical success, variceal regression, EV progression, rebleeding, and complications were evaluated. Statistical analysis included Fisher’s exact and unpaired t-tests, with significance set at p-value