Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

• Published in: Gut Vol. 48; no. 3; pp. 390 - 396
• Main Authors: Pomier-Layrargues, G, Villeneuve, J-P, Deschênes, M, Bui, B, Perreault, P, Fenyves, D, Willems, B, Marleau, D, Bilodeau, M, Lafortune, M, Dufresne, M-P
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.03.2001; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adolescent; Adult; Aged; Analysis of Variance; Biological and medical sciences; Care and treatment; cirrhosis; Diseases of the digestive system; Endoscopy; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - surgery; Esophageal varices; Failure; Female; Gastrointestinal bleeding; Gastrointestinal Hemorrhage - prevention & control; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - prevention & control; Humans; Length of Stay; Ligation - methods; Liver cirrhosis; Liver Cirrhosis - complications; Liver diseases; Logistic Models; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Patients; portal hypertension; Portasystemic Shunt, Transjugular Intrahepatic - methods; Quality of life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Secondary Prevention; Statistics, Nonparametric; Studies; Surgery; Survival Analysis; transjugular intrahepatic portosystemic shunt; Treatment Outcome; Ultrasonic imaging; variceal band ligation; variceal bleeding; Veins & arteries; Human; Relapse; Portal circulation disease; Liver; Esophageal disease; Instrumentation therapy; Cardiovascular disease; Hepatic disease; Hemorrhage; Transjugular intrahepatic portosystemic shunt; Venous disease; Esophagus; Esophagoscopy; Vascular disease; Prevention; Cirrhosis; Ligature; Digestive diseases; Complication; Endoscopy; Comparative study; Varix
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.48.3.390

BACKGROUND AND AIMS The transjugular intrahepatic portosystemic shunt (TIPS) is a new therapeutic modality for variceal bleeding. In this study we compared the two year survival and rebleeding rates in cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding. METHODS Eighty cirrhotic patients (Pugh score 7–12) with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding. RESULTS Mean follow up was 581 days in the ligation group and 678 days in the TIPS group. The two year survival rate was 57% in the TIPS group and 56% in the ligation group (NS); the incidence of variceal rebleeding after two years was 18% in the TIPS group and 66% in the ligation group (p<0.001). Uncontrolled rebleeding occurred in 11 patients in the ligation group (eight were rescued by emergency TIPS) but in none of the TIPS group. The incidence of encephalopathy at two years was 47% in the TIPS group and 44% in the ligation group (NS). CONCLUSIONS TIPS did not increase the two year survival rate compared with variceal band ligation after variceal bleeding in cirrhotic patients with moderate or severe liver failure. It significantly reduced the incidence of variceal rebleeding without increasing the rate of encephalopathy.