Treatment of peristomal hemorrhage: A review of outcomes and comparison of two minimally invasive techniques

• Published in: Diagnostic and interventional imaging Vol. 99; no. 12; pp. 793 - 799
• Main Authors: Young, S., Wong, J., Rosenberg, M., Golzarian, J., Frank, N.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.12.2018
• Subjects: Peristomal varices; Sclerotherapy; Transjugular intrahepatic portosystemic shunt; Variceal hemorrhage; Variceal hemorrhage; Sclerotherapy; Transjugular intrahepatic portosystemic shunt; Peristomal varices
• ISSN: 2211-5684; 2211-5684
• DOI: 10.1016/j.diii.2018.08.017

The purpose of this study was to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments in patients with peristomal variceal bleeding. Ten patients who underwent sclerotherapy (n = 3 patients), TIPS placement (n = 5 patients) or both (n= 2 patients) for peristomal variceal bleeding were retrospectively reviewed. There were 6 women and 4 men, with a mean age of 62.6 years (range: 44–84 years). Data pertaining to the technical aspects of the procedure, demographics, and information regarding the underlying cause of ostomy and portal hypertension were collected. Treatment was considered a primary success if no further hemorrhage occurred. No differences in primary success were found between TIPS cohort (100%) and sclerotherapy cohort (40%) (P=0.4). Sclerotherapy patients had a poorer nutritional status (mean albumin serum level of 2.04g/dL in the sclerotherapy group and 2.95g/dL in theTIPS group; P=0.04) and worse liver function (mean total bilirubin serum level of 4.9mg/dL in the sclerotherapy group and 1.6mg/dL in the TIPS group; P=0.07). While further investigation is needed, TIPS may be more effective than sclerotherapy in treating peristomal variceal bleeding. However, sclerotherapy may serve as an effective bridging mechanism in critically ill patients.