Short-term rebleeding rates for isolated gastric varices managed by transjugular intrahepatic portosystemic shunt versus balloon-occluded retrograde transvenous obliteration.

Abstract

PURPOSE:

To assess the short-term rebleeding rate associated with the use of a transjugular intrahepatic portosystemic shunt (TIPS) compared with balloon-occluded retrograde transvenous obliteration (BRTO) for management of gastric varices (GV).

MATERIALS AND METHODS:

A single-center retrospective comparison of 50 patients with bleeding from GV treated with a TIPS or BRTO was performed. Of 50 patients, 27 (17 men and 10 women; median age, 55 y; range, 31-79 y) received a TIPS with covered stents, and 23 (12 men and 11 women; median age, 52 y; range, 23-83 y) underwent a BRTO procedure with a foam sclerosant. All study subjects had clinical and endoscopic evidence of isolated bleeding GV and were hemodynamically stable at the time of the procedure. Clinical and endoscopic follow-up was performed. Kaplan-Meier analysis was used to evaluate rebleeding rates from the GV.

RESULTS:

The technical success rate was 100% in the TIPS group and 91% in the BRTO group (P = .21). Major complications occurred in 4% of the patients receiving TIPS and 9% of patients the undergoing BRTO (P = .344). Encephalopathy was reported in 4 of 27 (15%) patients in the TIPS group and in none of the patients in the BRTO group (0%; P = .12). At 12 months, the incidence of rebleeding from a GV source was 11% in the TIPS group and 0% in the BRTO group (P = .25).

CONCLUSIONS:

BRTO appears to be equivalent to TIPS in the short-term for management of bleeding GV. Further comparative studies are warranted to determine optimal management strategies in individual patients.

• Authors: Saher S Sabri, Nadine Abi-Jaoudeh, Warren Swee, Wael E Saad, Ulku C Turba, Stephen H Caldwell, John F Angle, Alan H Matsumoto
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 25 Issue 3 Pg. 355-61 (Mar 2014) ISSN: 1535-7732 [Electronic] United States
• PMID: 24468043 (Publication Type: Comparative Study, Controlled Clinical Trial, Journal Article)
• Copyright: Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Balloon Occlusion (methods)
• Esophageal and Gastric Varices (complications, diagnostic imaging, surgery)
• Female
• Gastrointestinal Hemorrhage (diagnostic imaging, etiology, surgery)
• Humans
• Male
• Middle Aged
• Portal Vein (surgery)
• Portasystemic Shunt, Transjugular Intrahepatic (methods)
• Radiography
• Recurrence
• Retrospective Studies
• Treatment Outcome
• Young Adult