{"id":2273,"date":"2026-07-08T13:48:02","date_gmt":"2026-07-08T13:48:02","guid":{"rendered":"https:\/\/neuroandvascular.com\/blog\/?p=2273"},"modified":"2026-07-08T13:48:02","modified_gmt":"2026-07-08T13:48:02","slug":"tipss-vs-brto-for-gastric-varices","status":"publish","type":"post","link":"https:\/\/neuroandvascular.com\/blog\/tipss-vs-brto-for-gastric-varices\/","title":{"rendered":"TIPSS vs BRTO for Gastric Varices"},"content":{"rendered":"<h1><strong>TIPSS vs BRTO for Gastric Varices<\/strong><\/h1>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-2281\" src=\"https:\/\/neuroandvascular.com\/blog\/wp-content\/uploads\/2026\/07\/tipss-vs-brto-300x169.png\" alt=\"\" width=\"2240\" height=\"1260\" srcset=\"https:\/\/neuroandvascular.com\/blog\/wp-content\/uploads\/2026\/07\/tipss-vs-brto-300x169.png 300w, https:\/\/neuroandvascular.com\/blog\/wp-content\/uploads\/2026\/07\/tipss-vs-brto-1024x576.png 1024w, https:\/\/neuroandvascular.com\/blog\/wp-content\/uploads\/2026\/07\/tipss-vs-brto-768x432.png 768w, https:\/\/neuroandvascular.com\/blog\/wp-content\/uploads\/2026\/07\/tipss-vs-brto-1536x864.png 1536w, https:\/\/neuroandvascular.com\/blog\/wp-content\/uploads\/2026\/07\/tipss-vs-brto.png 1672w\" sizes=\"auto, (max-width: 2240px) 100vw, 2240px\" \/><\/p>\n<p><span style=\"font-weight: 400;\">Gastric varices are enlarged veins that develop in the stomach due to increased pressure within the portal venous system, a condition known as portal hypertension. They are most commonly seen in patients with liver cirrhosis and can lead to life-threatening gastrointestinal bleeding if left untreated.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Advances in Interventional Radiology have transformed the management of gastric varices through minimally invasive procedures such as <\/span><b>Transjugular Intrahepatic Portosystemic Shunt (TIPSS)<\/b><span style=\"font-weight: 400;\"> and <\/span><b>Balloon-Occluded Retrograde Transvenous Obliteration (<a href=\"https:\/\/www.cirse.org\/patients\/general-information\/ir-procedures\/balloon-occluded-retrograde-transvenous-obliteration-brto\/\">BRTO<\/a>)<\/b><span style=\"font-weight: 400;\">. Both procedures are highly effective but serve different purposes depending on the patient&#8217;s anatomy, liver function, and underlying disease.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Understanding the differences between TIPSS and BRTO can help patients and <a href=\"https:\/\/neuroandvascular.com\/dr-suresh-giragani.html\">Best Interventional radiologist in Hyderabad\u00a0<\/a> determine the most appropriate treatment strategy.<\/span><\/p>\n<h2><b>What Are Gastric Varices?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Gastric varices are dilated veins within the stomach that develop when blood flow through the liver becomes obstructed, causing portal hypertension.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Common causes include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Liver cirrhosis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Portal vein thrombosis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chronic liver disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Splenic vein thrombosis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Advanced portal hypertension<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Although less common than esophageal varices, gastric varices are often associated with more severe bleeding episodes and higher mortality rates.<\/span><\/p>\n<h2><b>What Is TIPSS?<\/b><\/h2>\n<p><b>Transjugular Intrahepatic Portosystemic Shunt (TIPSS)<\/b><span style=\"font-weight: 400;\"> is a minimally invasive image-guided procedure performed by an Interventional Radiologist.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">During <a href=\"https:\/\/neuroandvascular.com\/\">TIPSS Procedure in hyderabad <\/a><\/span><span style=\"font-weight: 400;\">a stent is placed within the liver to create a channel between the portal vein and hepatic vein. This allows blood to bypass the scarred liver and significantly reduces portal venous pressure.<\/span><\/p>\n<h3><b>Benefits of TIPSS<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reduces portal hypertension<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Controls active variceal bleeding<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prevents recurrent bleeding<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Helps manage refractory ascites<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Minimally invasive alternative to surgery<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Improves portal blood flow dynamics<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">TIPSS is particularly useful for patients with multiple complications of portal hypertension.<\/span><\/p>\n<h2><b>What Is BRTO?<\/b><\/h2>\n<p><b>Balloon-Occluded Retrograde Transvenous Obliteration (BRTO)<\/b><span style=\"font-weight: 400;\"> is another minimally invasive procedure used specifically for gastric varices associated with a gastrorenal shunt.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">During BRTO:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A catheter is inserted through a vein<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A balloon temporarily blocks the gastrorenal shunt<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A sclerosant or embolic agent is injected<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The gastric varices are permanently obliterated<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Unlike TIPSS, BRTO directly treats the varices without reducing portal pressure.<\/span><\/p>\n<h3><b>Benefits of BRTO<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Excellent control of gastric variceal bleeding<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Lower risk of hepatic encephalopathy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Preserves liver blood flow<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Effective treatment for gastric varices with gastrorenal shunts<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">May improve liver function in selected patients<\/span><\/li>\n<\/ul>\n<h2><b>TIPSS vs BRTO: Key Differences<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Both TIPSS and BRTO are highly effective treatments, but they work through different mechanisms.<\/span><\/p>\n<p><b>TIPSS<\/b><span style=\"font-weight: 400;\"> addresses the underlying portal hypertension by creating a new pathway for blood flow. By reducing portal pressure, it decreases the risk of bleeding from both gastric and esophageal varices and can also help manage ascites.<\/span><\/p>\n<p><b>BRTO<\/b><span style=\"font-weight: 400;\">, on the other hand, directly eliminates gastric varices by closing the abnormal shunt that supplies them. While it effectively controls gastric variceal bleeding, it does not reduce portal hypertension and may actually increase portal pressure in some patients.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another important distinction is the risk of hepatic encephalopathy. Since TIPSS diverts blood away from the liver, some patients may develop encephalopathy after the procedure. BRTO generally carries a lower risk because it preserves normal liver blood flow.<\/span><\/p>\n<h2><b>When Is TIPSS Recommended?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">TIPSS may be preferred in patients with:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Severe portal hypertension<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recurrent variceal bleeding<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bleeding from both gastric and esophageal varices<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Refractory ascites<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Failure of endoscopic therapy<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">It is often considered when the goal is to reduce portal pressure and manage multiple complications of liver disease.<\/span><\/p>\n<h2><b>When Is BRTO Recommended?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">BRTO is commonly recommended for patients with:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Isolated gastric varices<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gastrorenal shunts<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Previous episodes of hepatic encephalopathy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Preserved liver function<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Contraindications to TIPSS<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For selected patients, BRTO provides excellent bleeding control while preserving liver function.<\/span><\/p>\n<h2><b>Which Procedure Is More Cost-Effective?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">The cost-effectiveness of TIPSS and BRTO depends on the patient&#8217;s condition and long-term outcomes.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">TIPSS may offer broader benefits because it treats portal hypertension and related complications such as ascites. However, it may require ongoing monitoring for stent patency and hepatic encephalopathy.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">BRTO often provides durable control of gastric varices with lower encephalopathy rates but may require additional surveillance because portal hypertension persists.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The most cost-effective option is the procedure best suited to the patient&#8217;s specific anatomy and clinical condition.<\/span><\/p>\n<h2><b>Can TIPSS and BRTO Be Combined?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Yes. In some complex cases, Interventional Radiologists may combine TIPSS and BRTO to achieve optimal control of portal hypertension and gastric variceal bleeding.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The decision is individualized based on:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Severity of portal hypertension<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Liver function<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Presence of gastrorenal shunts<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Risk of encephalopathy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Overall clinical status<\/span><\/li>\n<\/ul>\n<h2><b>Advanced Gastric Varices Treatment in Hyderabad<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Patients seeking advanced treatment for gastric varices and portal hypertension can benefit from modern Interventional Radiology procedures available in Hyderabad.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Available treatments include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">TIPSS Procedure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">BRTO Procedure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Portal Vein Interventions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Variceal Embolization<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Endovascular Management of Portal Hypertension<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">These minimally invasive procedures help reduce bleeding risk while avoiding major surgery.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dr. Suresh Giragani specializes in advanced vascular and endovascular interventions, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">TIPSS (Transjugular Intrahepatic Portosystemic Shunt)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">BRTO (Balloon-Occluded Retrograde Transvenous Obliteration)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Portal Hypertension Interventions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Variceal Embolization<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Liver Vascular Procedures<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Neurovascular and Peripheral Vascular Interventions<\/span><\/li>\n<\/ul>\n<h2><b>Frequently Asked Questions (FAQs)<\/b><\/h2>\n<h3><b>What is the main difference between TIPSS and BRTO?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">TIPSS reduces portal pressure by creating a shunt within the liver, while BRTO directly obliterates gastric varices through an existing gastrorenal shunt.<\/span><\/p>\n<h3><b>Which procedure is better for gastric varices?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">BRTO is often preferred for isolated gastric varices with a gastrorenal shunt, whereas TIPSS is beneficial when portal hypertension and its complications also require treatment.<\/span><\/p>\n<h3><b>Does TIPSS cure portal hypertension?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">TIPSS does not cure portal hypertension but significantly reduces portal pressure and helps control its complications.<\/span><\/p>\n<h3><b>Which procedure has a lower risk of hepatic encephalopathy?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">BRTO generally has a lower risk of hepatic encephalopathy because it preserves normal liver blood flow.<\/span><\/p>\n<h3><b>Can gastric varices recur after treatment?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Recurrence is possible after either procedure, although both provide excellent long-term bleeding control when combined with appropriate follow-up.<\/span><\/p>\n<h3><b>Are TIPSS and BRTO surgical procedures?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">No. Both are minimally invasive catheter-based procedures performed by Interventional Radiologists without the need for open surgery.<\/span><\/p>\n<h2><b>Conclusion<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Both TIPSS and BRTO are effective minimally invasive treatments for gastric varices, but their indications differ. <\/span><b>BRTO is often the preferred treatment for isolated gastric varices with a gastrorenal shunt<\/b><span style=\"font-weight: 400;\">, as it directly obliterates the varices, preserves liver blood flow, and carries a lower risk of hepatic encephalopathy. <\/span><b>TIPSS is particularly valuable when gastric varices are associated with esophageal varices, refractory ascites, or other complications of portal hypertension<\/b><span style=\"font-weight: 400;\">, as it reduces portal pressure and addresses multiple disease manifestations. The choice of treatment should be individualized based on the patient&#8217;s anatomy, liver function, and overall clinical condition.<\/span><\/p>\n<p><strong>About the Author:<\/strong><\/p>\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/neuroandvascular.com\/blog\/wp-content\/uploads\/2021\/12\/nu.jpg\" alt=\"\" \/><\/figure>\n<h5 id=\"name-dr-suresh-giragani\" class=\"wp-block-heading\"><strong>Name:<\/strong>\u00a0DR . SURESH GIRAGANI<\/h5>\n<p><strong>INTERVENTIONAL RADIOLOGIST<\/strong><\/p>\n<p>DR. SURESH GIRAGANI CONSULTANT <a href=\"https:\/\/neuroandvascular.com\/dr-suresh-giragani.html\">INTERVENTIONAL RADIOLOGIST<\/a> at Apollo hospitals Jubilee Hills has more than Seventeen years of clinical experience in vascular interventions with a special interest in neurovascular and peripheral vascular disease interventional procedures.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>TIPSS vs BRTO for Gastric Varices Gastric varices are enlarged veins that develop in the stomach due to increased pressure within the portal venous system, a condition known as portal hypertension. They are most commonly seen in patients with liver [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":2281,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29],"tags":[226,223,224,216,228,227,54,218,215,217,219,225,220,222,221],"class_list":["post-2273","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neurovascular","tag-advanced-gastric-varices-treatment-in-hyderabad","tag-balloon-occluded-retrograde-transvenous-obliteration-brto","tag-benefits-of-brto","tag-brto-procedure","tag-does-tipss-cure-portal-hypertension","tag-interventional-radiology-procedures-available-in-hyderabad","tag-liver-cancer-treatments-in-hyderabad","tag-liver-treatment-in-hyderabad","tag-tipss-procedure","tag-tipss-procedure-in-hyderabad","tag-tipss-vs-brto-for-gastric-varices","tag-tipss-vs-brto-key-differences","tag-what-are-gastric-varices","tag-what-is-brto","tag-what-is-tipss"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>TIPSS vs BRTO for Gastric Varices<\/title>\n<meta name=\"description\" content=\"Transjugular Intrahepatic Portosystemic Shunt (TIPSS) and Balloon-Occluded Retrograde Transvenous Obliteration (BRTO).\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/neuroandvascular.com\/blog\/tipss-vs-brto-for-gastric-varices\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"TIPSS vs BRTO for Gastric Varices\" \/>\n<meta property=\"og:description\" content=\"Transjugular Intrahepatic Portosystemic Shunt (TIPSS) and Balloon-Occluded Retrograde Transvenous Obliteration (BRTO).\" \/>\n<meta property=\"og:url\" content=\"https:\/\/neuroandvascular.com\/blog\/tipss-vs-brto-for-gastric-varices\/\" \/>\n<meta property=\"og:site_name\" content=\"DR. 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