The aim of this study was to compare the efficacy of transjugular intrahepatic
portosystemic shunt (
TIPS) with that of endoscopic
sclerotherapy (ES) in the long-term management of patients with
cirrhosis after variceal
bleeding. Seventy-eight consecutive cirrhotic patients with recent variceal
bleeding were randomly allocated to either
TIPS (n=38) or ES (n=40). All patients were in good condition at randomization. The mean follow-up was 1116+/-92 days in the
TIPS group and 1047+/-102 days in the ES group. Differences in rebleeding from any source (18.4% vs. 32.5%) and esophageal variceal rebleeding (15.7% vs. 27.5%) were not significantly different between the two groups (P>0.05). The mortality rates were similar in both treatment groups. Shunt dysfunction was noted in 27 patients (71%) in the
TIPS group. There were more numbers of
rehospitalization during follow-up in the
TIPS group than in the ES group (2.6+/-0.4 vs. 1.1+/-0.2) (P<0.01).
TIPS and ES are equally effective in the prevention of variceal rebleeding. However,
TIPS is associated with high incidence of shunt dysfunction, which lead to more
rehospitalization. Therefore,
TIPS may not be a first-line treatment for the prevention of variceal rebleeding in cirrhotic patients who are in stable condition.