Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population

• Published in: Scandinavian journal of gastroenterology Vol. 53; no. 1; p. 70
• Main Authors: Rosenqvist, K, Sheikhi, R, Nyman, R, Rorsman, F, Sangfelt, P, Ebeling Barbier, C
• Format: Journal Article
• Language: English
• Published: England 02.01.2018
• Subjects: Adult; Aged; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - surgery; Female; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - surgery; Hepatic Encephalopathy - pathology; Humans; Liver Cirrhosis - complications; Male; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic; Recurrence; Retrospective Studies; Severity of Illness Index; Stents; Survival Analysis; Sweden; Young Adult; portal hypertension; portosystemic gradient; transjugular intrahepatic portosystemic shunt; re-bleeding; hepatic encephalopathy; TIPS dysfunction; Variceal bleeding; liver cirrhosis; TIPS
• ISSN: 1502-7708
• DOI: 10.1080/00365521.2017.1386795

To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting. Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016. Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child-Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of ≥5 mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE. TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child-Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of ≥5 mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.