TIPSS trials: Design determines outcome

Abstract

survival rates for shunted and endoscopically treated patients Methods: Sixty-three consecutive cirrhotic patients with a of 90% and 89%, and 2-year survival rates of 79% and 82%, hemorrhage from esophageal varices were included. Thirtyrespectively. The incidence of clinically significant hepatic two patients were randomly allocated to ES and 31 to TIPS encephalopathy after 1 year was higher in the shunt group groups. Results: One patient in each group died before the (36% vs 18%, P Å 0.011). Interpretation: These results sugtherapeutic procedure could be performed. During a mean gest that the transjugular shunt is more effective than endofollow-up period of 15 months, variceal rebleeding occurred scopic treatment in prevention of variceal rebleeding but has in 51.6% of the patients in the ES group and 23% of those in a considerable risk of hepatic encephalopathy. Survival is simthe TIPS group. Uncontrolled rebleeding occurred in 10 of ilar in the two groups. 31 patients in the ES group, whereas rebleeding did not occur in any patient of the TIPS group. Hepatic encephalopathy was more frequent in TIPS patients (33.3%) than in those treated (3) Cello JP, Ring EJ, Olcott EW, Koch J, Gordon R, Sandhu by ES (13%). However, mortality was similar in both treat-J, Morgan DR, et al. Endoscopic sclerotherapy compared with ment groups. Conclusions: These preliminary results suggest percutaneous transjugular intrahepatic portosystemic shunt that TIPS is more effective than ES in the prevention of vari-after initial sclerotherapy in patients with acute variceal hemceal rebleeding in cirrhotic patients, even though no difference orrhage: a randomized, controlled trial. Ann Intern Med in survival was observed.

Transjugular Intrahepatic Portosystemic Stent Shunt for Acute Variceal Bleeding: An Option?

“…Considering the high mortality associated with uncontrolled variceal bleeding, an effective TIPS So far, three published uncontrolled trials report on TIPS placement in the setting of uncontrolled variceal rescue obviously improves the overall survival data -analyzed on an intention-to-treat basis -in favor of the bleeding after one to two endoscopic interventions [9][10][11]. One study compared the outcome of emergency TIPS endoscopy cohort [17]. All authors reported TIPS as an effective rescue measure without giving separated early with an historic control group using esophageal transection as salvage treatment [10].…”