Transjugular Intrahepatic Portosystemic Shunt versus Endoscopic Sclerotherapy in the Elective Treatment of Recurrent Variceal Bleeding

Popovic, Peter; Štabuc, Borut; Skok, Pavel; Šurlan, Miloš

doi:10.1177/147323001003800341

Cited by 9 publications

(6 citation statements)

References 26 publications

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“…From an initial 395 studies, 214 records were screened and 33 full-length articles were assessed. Twenty-one studies were included in the final analysis, of which 12 studies reported on the outcomes with SEMS [7-9, 26-34] and 9 reported on the outcomes with TIPS [6,[35][36][37][38][39][40][41][42].…”

Section: Search Results and Population Characteristicsmentioning

confidence: 99%

Self-expanding metal stents versus TIPS in treatment of refractory bleeding esophageal varices: a systematic review and meta-analysis

et al. 2020

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Background and study aims Refractory and recurrent esophageal variceal (EV) bleeding can be life threatening. Self-expanding metal stents (SEMS) have been used as a “bridge” therapy. However, their role in the treatment protocol is not established due to paucity in data. Methods We searched multiple databases from inception through May 2019 to identify studies that reported on SEMS and TIPS in refractory EV hemorrhage. Our primary goals were to analyze and compare the pooled all-cause mortality, immediate bleeding control and rebleeding rates. Results Five hundred forty-seven patients from 21 studies were analyzed (SEMS: 12 studies, 176 patients; TIPS: 9 studies, 398 patients). The pooled rate of all-cause mortality with SEMS was 43.6 % (95 % CI 28.6–59.8, I2 = 38) and with TIPS was 27.9 % (95 % CI 16.3–43.6, I2 = 91). The pooled rate of immediate bleeding control with SEMS was 84.5 % (95 % CI 74–91.2, I2 = 40) and with TIPS was 97.9 % (95 % CI 87.7–99.7, I2 = 0). The pooled rate of rebleeding with SEMS was 19.4 % (95 % CI 11.9–30.4, I2 = 32) and with TIPS was 8.8 % (95 % CI 4.8–15.7, I2 = 40). Conclusion Use of SEMS in refractory EV hemorrhage demonstrates acceptable immediate bleeding control with good technical success rate. Mortality and rebleeding rates were lesser with TIPS, however, its superiority and/ or inferiority cannot be validated due to limitations in the comparison methodology.

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Section: Search Results and Population Characteristicsmentioning

confidence: 99%

Self-expanding metal stents versus TIPS in treatment of refractory bleeding esophageal varices: a systematic review and meta-analysis

et al. 2020

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“…Studies which could evaluate the role of elective TIPS in comparison to ET in patients with recurrent variceal bleeding episodes are rare. 12 There is even fewer studies which could analyse the longterm effect of TIPS vs . ET.…”

Section: Discussionmentioning

confidence: 99%

“…TIPS was placed using a technique described in available literature, the procedure took place in the interventional radiology suite. 12 , 15 Prior to elective TIPS, patients were hemodynamically and systemically stable. After indirect portography between the portal and hepatic veins, shunt tracts were lined with wallstent endoprosthesis (Wallstent, Schneider, Switzerland) or polytetrafluoroethylene-covered stents (GoreÒViatorrÒ; United States).…”

Section: Methodsmentioning

confidence: 99%

“… 7 , 8 , 9 , 10 , 11 Studies which could evaluate the role of elective TIPS in comparison to combined ET and NSBB treatment in patients with recurrent variceal bleeding episodes are rare. 8 , 12 , 13 According to literature, there are even fewer studies which analysed the long-term effect of TIPS vs . ET, 30 months being the longest observation period in terms of survival.…”

Section: Introductionmentioning

confidence: 99%

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

Korsic

Štabuc

Skok

et al. 2021

Radiology and Oncology

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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.

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“…71 Peter Popovič et al reported TIPS versus endoscopic sclerotherapy in the elective treatment of recurrent variceal bleeding ( Figures 10 – 15 ). 72 …”

Section: Interventional Radiologymentioning

confidence: 99%

Slovenian experience from diagnostic angiography to interventional radiology

Pavčnik

2014

Radiology and Oncology

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BackgroundThe purpose of writing this article is to document the important events and people in the first 50 years of diagnostic angiography and interventional radiology in Slovenia. During this period not only did the name of the institutions and departments change, but also its governance.ConclusionsThis depicted the important roles different people played at various times in the cardiovascular divisions inside and outside of the diagnostic and interventional radiology. Historical data show that Slovenian radiology has relatively immediately introduced the new methods of interventional radiology in clinical practice.

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Transjugular Intrahepatic Portosystemic Shunt versus Endoscopic Sclerotherapy in the Elective Treatment of Recurrent Variceal Bleeding

Cited by 9 publications

References 26 publications

Self-expanding metal stents versus TIPS in treatment of refractory bleeding esophageal varices: a systematic review and meta-analysis

Self-expanding metal stents versus TIPS in treatment of refractory bleeding esophageal varices: a systematic review and meta-analysis

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

Slovenian experience from diagnostic angiography to interventional radiology

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