Transjugular Intrahepatic Portosystemic Shunt versus Endoscopic Therapy: Randomized Trials for Secondary Prophylaxis of Variceal Bleeding: an Updated Meta-Analysis

Burroughs, A K; Vangeli, Marcello

doi:10.1080/003655202317284138

Cited by 124 publications

(82 citation statements)

References 13 publications

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“…TIPS can be used to prevent variceal rebleeding and is more effective in preventing rebleeding than endoscopic therapy [16] . Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS.…”

Section: Hvpg Monitoring In Secondary Prophylaxismentioning

confidence: 99%

“…Transjugular intrahepatic portosystemic shunt (TIPS) can be used to prevent variceal rebleeding and is more effective in preventing rebleeding than endoscopic therapy [15,16] . In a recent study, the early use of TIPS in patients with cirrhosis and variceal bleeding has been assessed-Patients presenting with an acute variceal bleed were treated with vasoactive therapy and endoscopic therapy (band ligation or sclerotherapy) and then randomised to early TIPS with an extended polytetraflouroethylene stent within 24-72 h of presentation or continuation of vasoactive treatment, beta blockers and longterm endoscopic band ligation.…”

Section: Secondary Prophylaxismentioning

confidence: 99%

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Use of portal pressure studies in the management of variceal haemorrhage

Addley

Tham²,

Cash³

2012

WJGE

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Section: Hvpg Monitoring In Secondary Prophylaxismentioning

confidence: 99%

Section: Secondary Prophylaxismentioning

confidence: 99%

Use of portal pressure studies in the management of variceal haemorrhage

Addley

Tham²,

Cash³

2012

WJGE

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“…A recent meta-analysis [64] compared the effects of TIPS creation with those of endoscopic treatment with or without propranolol administration (i.e., conventional treatment) on recurrent bleeding, encephalopathy, and mortality in 948 patients.…”

Section: Prevention Of Recurrent Bleedingmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt

Ochs¹

2005

Dig Dis

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The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side portosystemic anastomosis. Since its introduction 16 years ago, more than 1,000 publications have appeared demonstrating broad acceptance and increasing clinical use. This review summarizes our present knowledge about technical aspects and complications, follow-up of patients and indications. A technical success rate near 100% and a low occurrence of complications clearly depend on the skills of the operator. The follow-up of the TIPS patient has to assess shunt patency, liver function, hepatic encephalopathy and the possible development of hepatocellular carcinoma. Shunt patency can best be monitored by duplex sonography and can avoid routine radiological revision. Short-term patency may be improved by anticoagulation, while such a treatment does not influence long-term patency. Stent grafts covered with expanded polytetrafluoroethylene show promising long-term patency comparable with that of surgical shunts. With respect to the indications of TIPS, much is known about treatment of variceal bleeding and refractory ascites. The thirteen randomized studies that are available to date show that survival is comparable in patients receiving TIPS or endoscopic treatment for acute or recurrent variceal bleeding. Another group comprises patients with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrated that TIPS improves these complications. Five randomized studies comparing TIPS with paracentesis and one study comparing TIPS with the peritoneo-venous shunt showed good response of ascites but controversial results on survival. In addition, TIPS has been successfully applied to patients with Budd-Chiari syndrome, portal vein thrombosis, before liver transplantation, and for the treatment of ectopic variceal bleeding.

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“…However, as compared with the therapeutic alternatives for secondary prophylaxis of variceal bleeding, e.g., endoscopic approaches [2, 3, 4]or drug treatment [5], TIPS insertion does not improve survival despite successful prevention of rebleeding. Therefore, intrahepatic shunting is currently considered to be a rescue strategy for failures of medical or endoscopic therapy [4]. The potential benefit of TIPS insertion depends on the individual situation: presumably, TIPS will improve the long-term prognosis only in patients in whom the recurrent bleeding episode itself determines the prognosis.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Renal Impairment and Sodium Imbalance in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunting for the Prevention of Variceal Rebleeding

Schepke

Roth²,

Koch³

et al. 2003

Digestion

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Background/Aim: Kidney function and portal pressure have prognostic relevance in nonshunted patients with cirrhosis. Since insertion of a transjugular intrahepatic portosystemic shunt (TIPS) reduces portal pressure and may improve the renal function, the aim of the present study was to investigate the prognostic role of renal impairment and portal hemodynamics in patients with compensated cirrhosis electively shunted due to recurrent variceal hemorrhages. Methods: Data of 101 consecutive and prospectively followed patients with compensated cirrhosis (bilirubin <5 mg/dl) undergoing elective TIPS due to recurrent variceal bleeding (45 died, and 8 were transplanted during the follow-up period) were evaluated in a multivariate Cox model. Results: Creatinine and sodium were identified as the only independent predictors of survival in this model. The 90th percentile of creatinine (>1.7 mg/dl) defined a subgroup with a similar poor prognosis as the 90th percentile of the model for end-stage liver disease (MELD) score. Neither baseline nor post-TIPS portal pressure correlated with the long-term outcome. Conclusions: In compensated patients undergoing TIPS due to variceal bleeding, renal impairment indicates a poor prognosis. Portal hemodynamic parameters are not predictive of survival in TIPS patients.

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Transjugular Intrahepatic Portosystemic Shunt versus Endoscopic Therapy: Randomized Trials for Secondary Prophylaxis of Variceal Bleeding: an Updated Meta-Analysis

Cited by 124 publications

References 13 publications

Use of portal pressure studies in the management of variceal haemorrhage

Use of portal pressure studies in the management of variceal haemorrhage

Transjugular Intrahepatic Portosystemic Shunt

Prognostic Impact of Renal Impairment and Sodium Imbalance in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunting for the Prevention of Variceal Rebleeding

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