ATU-06 Does the timing of TIPSS in patients with acute oesophageal variceal bleeding alter patient outcome?

Abstract

sustained virological response (cure) 12 weeks post treatment. 2 patients failed to achieve a cure. 17 patients are still on treatment or have not yet reached 12 weeks post treatment to assess for cure.From July to September 2017 49 patients were tested for blood borne viruses in the needle exchange. 21 were HCV antibody negative and 28 antibody positive. Of the 28 HCV antibody positive patients 15 were HCV antigen positive thus having active HCV infection and were referred for treatment. For the 3 month period at the end of the retrospective look back exercise 33 patients were tested; 25 were negative and 8HCV antibody positive but no patients had HCV antigen positivity. 5 patients were referred to the clinic following disclosure to needle exchange staff that they had previously tested HCV positive in another service or area. Conclusions Chaotic HCV patients can be successfully treated in the community where outreach services can be offered alongside harm minimisation services. Treating active IVDUs is achievable and can have an impact on the local prevalence of HCV amongst small chaotic communities.

Randomised clinical trial: standard of care versus early‐transjugular intrahepatic porto‐systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding

“…A potential explanation for reduced mortality after early‐TIPSS placement is the immediate reduction in portal hypertension and associated pathophysiological changes facilitating a reduction in gut bacterial translocation that would have otherwise amounted to a systemic inflammatory response 30,31 . Preliminary results from a large observational study of 281 patients in our centre, however, showed that time to TIPSS does not alter outcome following acute oesophageal variceal bleeding 32 therefore the 72‐hour post endoscopy window chosen by previous authors may be arbitrary 1 . We have provided analysis on all participants randomised to early‐TIPSS who received TIPSS placement regardless of time taken, and no survival benefit was seen when compared to our standard of care group.…”

Editorial: early TIPSS in patients with cirrhosis and acute variceal bleeding—the plot thickens!

“…Even if TIPSS was performed outside the 72 hours window, it may not have impacted on survival. Indeed, benefits of TIPSS placement following oesophageal variceal bleeding have been observed for up to 5 days post‐endoscopy 10 . Therefore, a more pragmatic approach to the time window for e‐TIPSS is an important consideration when designing the future trials.…”

Pre-emptive TIPSS in Acute Variceal Bleeding: Current Status, Controversies, and Future Directions

“…There are conflicting views on whether patients with Child-Pugh-Turcotte (CPT) class B disease and active bleeding or with MELD scores between 12 and 18 would benefit from pre-emptive TIPSS. 14,15 Whether p-TIPSS remains beneficial when performed after 72 hour is debatable, because real-world evidence suggests that benefits may be observed in patients who underwent TIPSS 16 after 72 hour of AVB. While active bleeding was defined as the presence of active bleeding during the insertion of endoscope, the reliability of the finding is also subject to the time that endoscopy was performed.…”