TIPS vs. endoscopic treatment for prevention of recurrent variceal bleeding: a long-term follow-up of 126 patients

Abstract

Background Recurrent bleeding from gastroesophageal varices is the most common life-threatening complication of portal hypertension. According to guidelines, transjugular intrahepatic portosystemic shunt (TIPS) should not be used as a first-line treatment and should be limited to those bleedings which are refractory to pharmacologic and endoscopic treatment (ET). To our knowledge, long-term studies evaluating the role of elective TIPS in comparison to ET in patients with recurrent variceal bleeding episodes are rare. Patients and methods This study was designed as a retrospective single-institution analysis of 70 patients treated with TIPS and 56 with ET. Patients were followed-up from inclusion in the study until death, liver transplantation, the last follow-up observation or until the end of our study. Results Recurrent variceal bleeding was significantly more frequent in ET group compared to patients TIPS group (66.1% vs. 21.4%, p < 0.001; χ2-test). The incidence of death secondary to recurrent bleeding was higher in the ET group (28.6% vs. 10%). Cumulative survival after 1 year, 2 years and 5 years in TIPS group compared to ET group was 85% vs. 83%, 73% vs. 67% and 41% vs. 35%, respectively. The main cause of death in patients with cumulative survival more than 2 years was liver failure. Median observation time was 47 months (range; 2–194 months) in the TIPS group and 40 months (range; 1–168 months) in the ET group. Conclusions In present study TIPS was more effective in the prevention of recurrent variceal bleeding and had lower mortality due to recurrent variceal bleeding compared to ET.

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

“…For secondary prophylaxis of variceal bleeding in cirrhosis, the combination of NSBBs with VBL seems more efficient in preventing re-bleeding compared with VBL alone 714–716 . TIPSS seems more effective than VBL in preventing re-bleeding in patients who first bleed while on beta-blockers, those with contraindications to beta-blockers or with refractory ascites, and in patients with fundal varices 696,697,714,717,718 . TIPSS seems more effective than VBL with propranolol in preventing recurrent oesophageal variceal bleeding in patients with advanced cirrhosis and portal vein thrombosis or with high hepatic venous pressure gradient 719,720 .…”

“…714 -716 TIPSS seems more effective than VBL in preventing re-bleeding in patients who first bleed while on beta-blockers, those with contraindications to betablockers or with refractory ascites, and in patients with fundal varices. 696,697,714,717,718 TIPSS seems more effective than VBL with propranolol in preventing recurrent oesophageal variceal bleeding in patients with advanced cirrhosis and portal vein thrombosis or with high hepatic venous pressure gradient. 719,720 According to recent systematic reviews and network meta-analysis, TIPSS may result in a larger decrease in symptomatic rebleeding than VBL, or VBL combined with NSBBs, whereas VBL is associated with fewer SAEs than sclerotherapy.…”

Non-tuberculosis extensive abdominal lymph node calcification leading to portal hypertension with esophageal and gastric variceal bleeding: a rare case report

“…Interventional treatment: There are currently two main procedures: transjugular intrahepatic portosystemic shunt (TIPS) and percutaneous transhepatic variceal embolization (PTVE). Studies have shown that TIPS is highly effective in stopping hemorrhage in cases of acute bleeding [ 9 ]. However, previous studies have concluded that TIPS can have a negative impact on the long-term prognosis of patients after the procedure and that TIPS is a difficult procedure to perform, making it difficult to generalise in the context of a large hepatitis population in China.…”

Variceal Hemorrhage: Decompression, Obliteration, or Both?

“…A recent retrospective study was conducted on 126 hemodynamically stable, nonbleeding patients (last bleed: mean 35 days) who had experienced recurrent episodes of variceal bleeding. 39 When the TIPS group was compared with the endoscopic therapy group, recurrence of variceal bleeding was significantly less for patients undergoing TIPS placement (66.1 vs. 21.4%, p < 0.001), and endoscopic therapy was the only significant independent predictor of recurrent bleeding (OR: 7, 95% CI: 3.0–16.5, p < 0.001). Cumulative survival rates between the two groups were similar, but the incidence of death secondary to variceal bleeding was lower for the TIPS group (10 vs. 28.6%).…”