Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis

Zhou, Guang‐Peng; Jiang, Yizhou; Sun, Li‐Ying; Zhu, Zhi‐Jun

doi:10.1007/s00330-020-07525-x

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…[693][694][695] In selected cirrhotic patients with severe AVB at high risk of treatment failure (Child-Turcotte-Pugh class C <14 points or Child-Turcotte-Pugh class B with active bleeding) early TIPSS within 72 h after oesophageal variceal bleeding, results in lower rates of failure to control bleeding and re-bleeding, and significant short-term reductions in mortality than in patients treated without early TIPSS. [696][697][698][699][700][701][702][703][704][705][706][707][708][709][710][711] According to a small observational study, emergency TIPSS could be effective as rescue therapy for patients with liver cirrhosis and uncontrolled variceal bleeding. 712 With low certainty of evidence, a Cochrane review found that surgical portosystemic shunts may have benefit over TIPSS for the treatment of refractory or recurrent variceal haemorrhage in people with cirrhotic portal hypertension.…”

Section: Variceal Bleedingmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

101

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Variceal Bleedingmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

101

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“…Guidelines consider TIPS a rescue therapy in cases of endoscopically uncontrollable acute variceal hemorrhage (two frustrated endoscopic therapy attempts within 24 h) and hemodynamically relevant recurrent bleeding within five days (secondary failure) [ 19 ]. Moreover, so-called early TIPS implantation within 24 to 72 h after endoscopic therapy of acute variceal hemorrhage is recommended in high-risk patients (CPS C, < 14 points) [ 22 ]. Hernández-Gea emphasizes the benefits of preemptive TIPS as a treatment of choice in CPS C patients with acute variceal bleeding [ 23 ], and Garcia Pagan et al reported that early use of TIPS significantly reduced treatment failure and mortality in CPS B and C patients [ 24 ].Various studies show higher patency rates with coated versus uncoated stents (76 vs. 27%), suggesting that coated stents should be preferred [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

25 years of experience with transjugular intrahepatic portosystemic shunt (TIPS): changes in patient selection and procedural aspects

et al. 2022

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Background TIPS is an established treatment for portal hypertension. The aim was to analyze how patient selection for TIPS implantation and procedural aspects have changed over 25 years. Routinely collected demographic, clinical, laboratory, and procedural data of 835 patients treated with TIPS in a single center were used. Time trends over the observational period from 1993 to 2018 were retrospectively analyzed. Descriptive statistical analysis was performed. Results The most common indication for TIPS implantation has changed significantly from secondary prevention of variceal hemorrhage in the early years to treatment of recurrent ascites. During the observation period, increasingly more severely ill patients became TIPS candidates. There was little change in MELD scores over this period (in total median 13.00; IQR 10.00–18.00). The proportion of patients with Child–Pugh C cirrhosis increased. The most frequent underlying diseases in total were alcohol-related liver disease (66.5%) and viral hepatitis (11.9%). However, shares of cryptogenic liver cirrhosis, autoimmune hepatitis, and NASH increased over time. The proportion of patients post liver transplant also increased. While bare metal stents were standard in the past, use of covered stents increased. The success rate of TIPS (defined by successful implantation and a decrease in the portosystemic pressure gradient ≤ 12 mmHg) increased significantly over time. The total success rate according to this definition was 84.9%. Conclusion The results of our analysis reflect technical developments in TIPS, especially in terms of stent material and gains in clinical experience, particularly regarding indications and patient selection for TIPS implantation.

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“…In high-risk patients, early (pre-emptive) transjugular intra-hepatic portosystemic shunts (TIPS) placement before treatment failure has been shown recently in many studies to prevent the risk of rebleeding and improve survival. [41][42][43][44][45][46][47][48]…”

Section: Prevention and Treatment Of Bleeding As Precipitantmentioning

confidence: 99%

To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

Kimmann

Laleman

et al. 2023

Semin Liver Dis

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Variceal bleeding is a consequence of severe portal hypertension in patients with liver cirrhosis. Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high-risk of treatment failure and short-term mortality. Treatment and/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic systemic shunts (TIPS), especially in the pre-emptive situation, have been found to efficiently control bleeding, prevent rebleeding and reduce short-term mortality. Therefore, TIPS placement should be considered as an option in the management of ACLF patients with variceal bleeding.

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Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis

Cited by 11 publications

References 27 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

25 years of experience with transjugular intrahepatic portosystemic shunt (TIPS): changes in patient selection and procedural aspects

To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

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