Transjugular intrahepatic portosystemic shunt in patients treated with a balloon tamponade for variceal hemorrhage without response to high doses of vasoactive drugs: A real-world multicenter retrospective study.

Abstract

OBJECTIVE:

To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) and non-TIPS therapy (endoscopy and/or nonselective beta-blockers [NSBB]) in patients with cirrhosis and active variceal hemorrhage who did not respond to high-dose vasoactive drugs and required balloon tamponade for hemostasis.

METHODS:

Medical records of cirrhotic patients who did not respond to high-dose vasoactive drugs and required balloon tamponade for hemostasis at five university hospitals in China between January 2011 and December 2018 were reviewed. Treatment outcomes were compared between the TIPS and the non-TIPS groups.

RESULTS:

Treatment failure of variceal hemorrhage within 5 days was reported in six patients of the non-TIPS group (N = 70) and none of the TIPS group (N = 66) (P = .028). The TIPS group had a higher 1-year variceal rebleeding-free rate compared with the non-TIPS group (95.5% vs 60.0%, P < .001). One patient treated with TIPS and nine with non-TIPS therapy experienced rebleeding within 5 days and 6 weeks after the intervention (P = .009). The cumulative 1-year survival rate was higher in the TIPS group than in the non-TIPS group (93.9% vs 78.6%, P = .01). The TIPS group had a higher incidence of hepatic encephalopathy within one year compared with the non-TIPS group (18.2% vs 4.3%, P = .026).

CONCLUSION:

For patients with cirrhosis and active variceal bleeding who do not respond to high-dose vasoactive agents and require a balloon tamponade for hemostasis, TIPS may be an appropriate treatment choice.

• Authors: Jing Bin Ni, Xiao Xing Xiang, Wei Wu, Shi Yao Chen, Feng Zhang, Ming Zhang, Chun Yan Peng, Jiang Qiang Xiao, Yu Zheng Zhuge, Chun Qing Zhang
• Journal: Journal of digestive diseases (J Dig Dis) Vol. 22 Issue 5 Pg. 236-245 (May 2021) ISSN: 1751-2980 [Electronic] Australia
• PMID: 33634958 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2021 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Chemical References

• Pharmaceutical Preparations

Topics

• Balloon Occlusion
• China
• Esophageal and Gastric Varices
• Gastrointestinal Hemorrhage (therapy)
• Humans
• Liver Cirrhosis
• Pharmaceutical Preparations
• Portasystemic Shunt, Transjugular Intrahepatic
• Recurrence
• Retrospective Studies
• Treatment Outcome