Emergency Transjugular Intrahepatic Portosystemic Shunt: an Effective and Safe Treatment for Uncontrolled Variceal Bleeding
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Uncontrolled variceal bleeding (VB) remains a great challenge for clinical treatment. Emergency transjugular intrahepatic portosystemic shunt (TIPS) is a salvage procedure, but unsatisfactory clinical outcomes and a high incidence of complications have been reported. This study aimed to investigate the effect and safety of emergency TIPS performed in our institution during recent years.
Fifty-eight consecutive cirrhotic patients with uncontrolled VB who underwent emergency TIPS from March 2009 to November 2017 in our hospital were followed until the last clinical evaluation, liver transplantation (LT), or death.
Overall, 5, 36, and 17 patients belonged to Child-Pugh class A, B, and C, respectively. TIPS was successfully performed in 57 (98.3%) patients at 89.5 h (mean) after initial bleeding. After TIPS, bleeding ceased in 52 (91.2%) patients, and 51 (89.5%) patients had a portal pressure gradient below 12 mmHg. Only one (1.8%) major procedure-related complication occurred without any clinical consequences, and no procedure-related deaths occurred. During follow-up, 55 hepatic encephalopathy (HE) episodes occurred in 19 (33.3%) patients, and the median time of the first HE episode was 3.1 months. Seven (12.3%) patients experienced shunt dysfunction after 8.7 months (median). The 6-week, 1-year, and 2-year variceal rebleeding rates were 10.5%, 17.1%, and 20.0%, respectively. The LT-free survival rates at 6 weeks, 1 year, and 2 years were 87.7%, 81.8% and 73.6%, respectively.
Our study highlights the fact that emergency TIPS could be effective for patients with liver cirrhosis and uncontrolled VB with few potential complications.
KeywordsEmergency Portal hypertension Transjugular intrahepatic portosystemic shunt Variceal bleeding
This study was supported by the National Natural Science Foundation of China (No. 81570554) and the Graduate Student’s Research and Innovation Fund of Sichuan University (No. 2018YJSY104). The authors declare no conflicts of interest regarding this paper.
Xiao Li and Xuefeng Luo contributed equally to TIPS operations. Yongjun Zhu and Xiaotan Xi were both in charge of collecting patient information and clinical data. Yongjun Zhu and Xiaoze Wang contributed to the statistics. All the authors helped to draft the manuscript. Li Yang and Xuefeng Luo approved the final manuscript.
Compliance with Ethical Standards
The protocol was approved by the West China Hospital of Sichuan University Biomedical Research Ethics Committee. The study was conducted according to the Declaration of Helsinki.
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