TIPSS for variceal bleeding in patients with idiopathic non‐cirrhotic portal hypertension: comparison with patients who have cirrhosis

Abstract

Background:In patients with idiopathic non-cirrhotic portal hypertension (INCPH), the usual recommended strategy for management of variceal bleeding is the same as that in cirrhosis. However, this policy has been challenged by the different natural history between INCPH and cirrhosis. Aim: To compare outcomes after transjugular intrahepatic portosystemic shunt (TIPSS) between INCPH and cirrhotic patients admitted for variceal bleeding. Methods: Between March 2001 and September 2015, 76 consecutive patients with biopsy-proven INCPH undergoing TIPSS for variceal bleeding in a tertiary-care centre were included. 76 patients with cirrhotic portal hypertension receiving TIPSS for variceal bleeding, and matched for age, sex, Child-Pugh class, stent type and index year of TIPSS creation served as controls.Results: Patients with INCPH, compared to those with cirrhosis, had significantly lower mortality (11% vs 36% at 5 years, adjusted HR, 0.37; 95% CI 0.15-0.87, P = 0.022), overt hepatic encephalopathy (16% vs 33% at 5 years, adjusted HR, 0.35; 95% CI 0.16-0.75, P = 0.007) and hepatic impairment, despite similar rates of further bleeding (33% vs 32% at 5 years, adjusted HR, 0.72; 95% CI 0.36-1.44, P = 0.358), and shunt dysfunction (35% vs 36% at 5 years, adjusted HR, 0.84; 95%

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

“…The rate of hepatic encephalopathy was high in most of these studies at more than 35% 2 114 116–118. The study by Lv et al showed lower mortality (12% vs 26%) and hepatic encephalopathy (32% vs 14%) in the INCPH group compared with cirrhotic patients 119. Ascites, malignancy, immunological disorders and female sex were associated with mortality.…”

“…Its diagnostic criteria have been described previously, and rests on liver histology which shows an absence of cirrhosis and the presence of subtle lesions such as hepatoportal sclerosis or nodular regenerative hyperplasia 114. There are only six published observational studies on the utility of TIPSS in INCPH 2 115–119. The largest of these from China compared patients with INCPH (n=76) with a matched control group of cirrhotic patients (n=76) over a median follow-up of 34 months.…”

Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Schistosomiasis-Induced Liver Fibrosis

“…The dose of warfarin was administered to reach the target international normalized ratio of 2–3. If potential thrombosis is found, long-term warfarin should be prescribed [23]. Lactulose was routinely administered in all patients after TIPS to induce 1–2 loose stools per day.…”

Causes and Management of Non-cirrhotic Portal Hypertension​

“…Transjugular intrahepatic porto-systemic shunt (TIPS) is to consider a valid option for the patients with variceal bleeding not controlled by medical and endoscopical treatment. In this setting, the results are favourable in patients with PSVD [31]. In fact, an international multicenter retrospective study showed an 80% 2-year survival in patients with PSVD treated with TIPS [32].…”