Abstract | OBJECTIVE: MATERIALS AND METHODS: All patients who underwent TIPS creation for hemorrhagic stomal varices refractory to medical or endoscopic therapy over a 20-year period (1992-2012) were included. Ten patients (mean age, 63 ± 12 years) were identified. Retrospective chart review was used to document demographic characteristics, procedure details, technical and clinical success, complications, recurrent hemorrhage, and need for repeat interventions. Patients underwent follow-up for an average of 2 years (range, 22 days-9.6 years). RESULTS: All patients had cirrhosis and portal hypertension. Average corrected sinusoidal pressures were 11 ± 2.4 mm Hg (range, 6-15 mm Hg) before TIPS placement and 4.3 ± 1.8 mm Hg (range, 2-8 mm Hg) after TIPS placement. Five patients (50%) underwent adjunctive embolization of stomal varices through the TIPS, which did not affect outcome. Complications included one patient each with a contrast allergy and renal failure. Six patients experienced complete resolution of bleeding without further intervention (60%). Four patients had recurrent stomal hemorrhage. Two of the four needed TIPS revision for occlusion; one underwent oversewing of the ostomy; and in one the hemorrhage resolved with conservative measures after confirmation of TIPS patency. CONCLUSION:
TIPS creation, with or without adjunctive variceal embolization, is a safe and effective treatment of refractory hemorrhagic stomal varices. Reintervention for recurrent bleeding may be required and appears effective.
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Authors | Amy R Deipolyi, Sanjeeva P Kalva, Rahmi Oklu, T Gregory Walker, Stephan Wicky, Suvranu Ganguli |
Journal | AJR. American journal of roentgenology
(AJR Am J Roentgenol)
Vol. 203
Issue 3
Pg. 668-73
(Sep 2014)
ISSN: 1546-3141 [Electronic] United States |
PMID | 25148174
(Publication Type: Clinical Trial, Journal Article)
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Topics |
- Aged
- Aged, 80 and over
- Esophageal and Gastric Varices
(complications, diagnosis, surgery)
- Female
- Fibrosis
(complications, diagnosis, surgery)
- Gastrointestinal Hemorrhage
(diagnosis, etiology, surgery)
- Humans
- Hypertension, Portal
(diagnosis, etiology, surgery)
- Male
- Middle Aged
- Portal Pressure
- Portasystemic Shunt, Transjugular Intrahepatic
- Treatment Outcome
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