Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial

Lv, Yong; Qi, Xingshun; He, Chuangye; Wang, Zhengyu; Yin, Zhihua; Niu, Jing; Guo, Wengang; Bai, Wei; Zhang, Hongbo; Xie, Hui; Yao, Liping; Wang, Jianhong; Li, Tao; Wang, Qiuhe; Chen, Hui; Li, Haibo; Wang, Enxing; Xia, Dongdong; Luo, Bohan; Li, Xiaomei; Yuan, Jie; Han, Na; Zhu, Ying; Xia, Jielai; Cai, Hong; Yang, Zhiping; Wu, Kaichun; Fan, Daiming; Han, Guohong

doi:10.1136/gutjnl-2017-314634

Cited by 141 publications

(124 citation statements)

References 51 publications

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“…31,34,35 So we can speculate that the baseline PPG value of most patients now receiving TIPS as a secondary prophylactic second-line treatment has already risen above 25 mmHg. 31,34,35 So we can speculate that the baseline PPG value of most patients now receiving TIPS as a secondary prophylactic second-line treatment has already risen above 25 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…In previous researches, the average baseline PPG value in most patients is above 25 mmHg. 31,34,35 So we can speculate that the baseline PPG value of most patients now receiving TIPS as a secondary prophylactic second-line treatment has already risen above 25 mmHg. That is to say, a lot of them should actually skip the EVL + NSBB treatments and directly undertake TIPS implantation, which may bring them a higher chance of survival and cut down unnecessary medical resources.…”

Section: Discussionmentioning

confidence: 99%

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Using transjugular intrahepatic portosystemic shunt as the first‐line therapy in secondary prophylaxis of variceal hemorrhage

Liu

Shi

Xiao

et al. 2019

J of Gastro and Hepatol

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Background and Aim This study aims to evaluate and compare the survival and other portal hypertension‐related complications of patients with portal pressure gradient (PPG) ≥ 25 mmHg using transjugular intrahepatic portosystemic shunt (TIPS) as the first‐line and second‐line therapies in secondary prophylaxis of variceal hemorrhage. Methods Fifty patients diagnosed with liver cirrhosis were enrolled in this retrospective study, with 35 of whom received TIPS as the first‐line therapy in secondary prophylaxis of variceal hemorrhage and 15 of whom as second‐line treatment. We observed and analyzed the survival, occurrence of variceal rebleeding and hepatic encephalopathy (HE) of patients in the two groups during the follow up. Results The technical success rate was 100%. In a median follow‐up time of 12 (1–37) and 15 (2–27) months, respectively, significant statistical difference was observed between the first‐line group and the second‐line group concerning cumulative survival rate (94.3% vs 66.7%, log–rank P = 0.01). But that was not the case when it comes to the cumulative rate of variceal rebleeding (8.6% vs 26.7%, log–rank P = 0.164) and HE (22.9% vs 20.0%, log–rank P = 0.793). And multivariate analysis indicated that group assignment (hazard ratio = 8.250, 95% confidence interval = 1.383–49.213, P = 0.021) was the only predictor of survival. Interestingly, we found that spleen diameter (hazard ratio = 0.578, 95% confidence interval = 0.393–0.849, P = 0.005) could be regarded as independent predictor of the occurrence of HE. Conclusions For patients with PPG ≥ 25 mmHg who have recovered from an episode of acute esophageal variceal hemorrhage, utilizing TIPS as the first‐line therapy to prevent rebleeding is demonstrated effective in improving the survival and therefore should be recommended to a wider range of clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using transjugular intrahepatic portosystemic shunt as the first‐line therapy in secondary prophylaxis of variceal hemorrhage

Liu

Shi

Xiao

et al. 2019

J of Gastro and Hepatol

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“…The most recent European Association for the Study of the Liver (EASL) guidelines (2018) do not recommend TIPSS for refractory ascites in patients with serum bilirubin >3 mg/dL and a platelet count lower than 75 x 10 9 /L, current hepatic encephalopathy grade ≥2 or chronic hepatic encephalopathy, concomitant active infection, progressive renal failure, severe systolic/diastolic cardiac dysfunction, or pulmonary hypertension (level 3; grade 1 evidence) . Advances in technology (ie covered stents) and operator experience in recent years have meant that certain patient characteristics, including portal vein thrombosis, are no longer deemed a contraindication to TIPSS . In contrast, the impact of cardiac dysfunction on TIPSS outcome remains a subject of considerable debate.…”

Section: Introductionmentioning

confidence: 99%

Diastolic dysfunction on echocardiography does not predict survival after transjugular intrahepatic portosystemic stent‐shunt in patients with cirrhosis

Armstrong

Gohar

Dhaliwal

et al. 2019

Aliment Pharmacol Ther

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Background: Cardiac dysfunction is frequently observed in patients with cirrhosis. There remains a paucity of data from routine clinical practice regarding the role of echocardiography in the pre-assessment of transjugular intrahepatic portosystemic stent-shunt. Aim:Our study aimed to investigate if echocardiography parameters predict outcomes after transjugular intrahepatic portosystemic stent-shunt insertion in cirrhosis. Methods: Patients who underwent echocardiography and transjugular intrahepatic portosystemic stent-shunt insertion at the liver unit (Birmingham, UK) between 1999 and 2016 were included. All echocardiography measures (including left ventricle ejection fraction; early maximal ventricular filling/late filling velocity ratio, diastolic dysfunction as per British Society of Echocardiography guidelines) were independently reviewed by a cardiologist. Predictors of 30-day and overall transplant free-survival were assessed. Results: One Hundred and Seventeen patients with cirrhosis (median age 56 years; 54% alcohol; Child-Pugh B/C 71/14.5%; Model For End-Stage Liver Disease 12) underwent transjugular intrahepatic portosystemic stent-shunt for ascites (n = 78) and variceal haemorrhage (n = 39). Thirty-day and overall transplant-free survival was 90% (n = 105) and 31% (n = 36), respectively, over a median 663 (IQR 385-2368) days follow-up. Model for End-Stage Liver Disease (P < 0.001) and Child-Pugh Score (P = 0.002) significantly predicted 30-day and overall transplant-free survival. Model for End-Stage Liver Disease ≥15 implied three-fold risk of death. Six per cent (n = 7) of patients pre-transjugular intrahepatic portosystemic stent-shunt had a history of ischaemic heart disease and 34% (n = 40) had 1 or more cardiovascular disease risk factors. Fifty per cent (n = 59) had an abnormal echocardiogram and 33% (n = 39) had grade 1-3 diastolic dysfunction. On univariate analysis none of the echocardiography measures pre-intervention were related to 30-day or overall transplant-free survival post-transjugular intrahepatic portosystemic stent-shunt. Conclusions: Ventricular, in particular diastolic dysfunction in patients with cirrhosis does not predict survival after transjugular intrahepatic portosystemic stent-shunt insertion. Model for End-Stage Liver Disease and Child-Pugh scores remain the best predictors of survival. Further prospective study is required to clarify the role of routine echocardiography prior to transjugular intrahepatic portosystemic stentshunt insertion.

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“…7 TIPS have been significantly improved over the past decades, and have emerged as one of the effective treatment options for cirrhosisrelated PVT. [8][9][10][11][12][13] There have been a few randomized controlled trials (RCTs) [11][12][13] that have compared the efficacy of TIPS with that of EVL in patients with PVT, showing a better effect of TIPS on the prevention of rebleeding. However, most previous trials focused on partial PVT.…”

Section: Introductionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt prevents rebleeding in cirrhotic patients having cavernous transformation of the portal vein without improving their survival

Sun

Wang

et al. 2019

J of Digest Diseases

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Objective To compare the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) and endoscopic variceal ligations (EVL) plus propranolol in decreasing rebleeding and improving survival rates in cirrhotic patients with cavernous transformation of the portal vein (CTPV). Methods Cirrhotic patients with CTPV and a history of variceal bleeding who were treated for recurrent variceal bleeding between June 2010 and July 2016 were identified and classified based on the treatment they received (TIPS or EVL plus propranolol). Their characteristics and clinical data were recorded. The rebleeding and long‐term survival rates between the two groups were analyzed. Results A total of 51 patients were included, of whom 25 were treated with TIPS and 26 with EVL plus propranolol. The mean duration of follow up was 21 months (range 1–47 months) in the former group and 27 months (range 6–73 months) in the latter group. The recurrent variceal bleeding‐free rate increased remarkably in the TIPS group compared with the EVL + propranolol group (P = 0.047). Three (14.3%) patients died in the TIPS group, and one (3.8%) in the EVL plus propranolol group (P = 0.305). Hepatic encephalopathy occurred in 14.3% (3/21) of the patients in the TIPS group and in 3.8% (1/26) in the EVL + propranolol group (P = 0.202). Conclusion TIPS appeared to be more effective in preventing rebleeding in cirrhotic patients with CTPV compared with EVL plus propranolol, without improving survival.

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Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial

Abstract: ClinicalTrials.gov: NCT01326949.

Cited by 141 publications

References 51 publications

Using transjugular intrahepatic portosystemic shunt as the first‐line therapy in secondary prophylaxis of variceal hemorrhage

Using transjugular intrahepatic portosystemic shunt as the first‐line therapy in secondary prophylaxis of variceal hemorrhage

Diastolic dysfunction on echocardiography does not predict survival after transjugular intrahepatic portosystemic stent‐shunt in patients with cirrhosis

Transjugular intrahepatic portosystemic shunt prevents rebleeding in cirrhotic patients having cavernous transformation of the portal vein without improving their survival

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