Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs. the right branch of the portal vein in advanced cirrhosis: a randomized trial.

Abstract

BACKGROUND/AIMS:

The transjugular intrahepatic portosystemic shunt (TIPS) is technically divided into TIPS through the left branch of the portal vein (TIPS-LBPV) and TIPS through the right branch of the portal vein (TIPS-RBPV). In order to compare their advantages and disadvantages, this randomized, controlled trial was designed to investigate their outcomes in advanced cirrhotic patients.

METHODS:

Seventy-two patients were randomly placed into TIPS-LBPV (36 patients) and TIPS-RBPV (36 patients, with four failures) groups, and they were prospectively followed for 2 years after TIPS implantation.

RESULTS:

Patients who underwent the two different kinds of TIPS were balanced during recruitment for this study. The incidences of overall encephalopathy and de novo encephalopathy in the TIPS-LBPV group were significantly lower than that of the TIPS-RBPV group during follow-up (P=0.036 and 0.012 respectively). The incidences of rebleeding or re-intervention and improvement of ascites were similar between groups (P>0.05). Patients undergoing TIPS-RBPV required more rehospitalization and incurred more costs than those who underwent TIPS-LBPV (P=0.030 and 0.039 respectively). There was no significant difference between the two groups in survival based on a survival curve constructed according to the Kaplan-Meier method (P>0.05).

CONCLUSION:

Patients undergoing TIPS-LBPV had a lower incidence of encephalopathy, less rehospitalization and lower costs after TIPS implantation compared with patients undergoing TIPS-RBPV.

• Authors: Lei Chen, Tianli Xiao, Wensheng Chen, Qingling Long, Rongjun Li, Dianchun Fang, Rongquan Wang
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 29 Issue 7 Pg. 1101-9 (Aug 2009) ISSN: 1478-3231 [Electronic] United States
• PMID: 19386025 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Ascites (etiology, surgery)
• Cost Savings
• Esophageal and Gastric Varices (etiology, surgery)
• Female
• Gastrointestinal Hemorrhage (etiology, surgery)
• Hepatic Encephalopathy (etiology)
• Hospital Costs
• Humans
• Kaplan-Meier Estimate
• Liver Cirrhosis (complications, economics, mortality, surgery)
• Liver Function Tests
• Male
• Middle Aged
• Patient Readmission
• Portal Vein
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects, economics, methods, mortality)
• Prospective Studies
• Recurrence
• Reoperation
• Risk Assessment
• Time Factors
• Treatment Outcome