Effect of embolization or sclerosis on variceal hemorrhage after transjugular intrahepatic portosystemic shunt placement

Abstract

while visualization of varices Z2mm on cross-sectional imaging was confirmed by two independent radiologists. ANOVA, Chi-squared, and Fisher's exact tests were used to assess continuous and categorical data. Results: 24 patients (38.7%) had persistent visible varices (VIS) on follow-up cross-sectional imaging, while 38 patients (61.3%) no longer had visible varices (NON-VIS). Except for age (57.5 yrs vs 50.9 yrs, p ¼ 0.032), preoperative characteristics did not differ between VIS and NON-VIS groups, and mean time to follow-up imaging (VIS 183 days vs NON-VIS 215 days, p ¼ 0.719) was similar. Variceal occlusion method (embolization vs embolization plus sclerotherapy) did not significantly affect the proportion of patients with visible varices (embolization 47.6% vs embolization plus sclerotherapy 36.6%, p ¼ 0.654). In patients with persistent varices, 22 (91.7%) showed esophageal varices, of which 17 (77.3%) protruded intraluminally, while 15 (62.5%) had gastric varices, of which 6 (40%) protruded intraluminally. Mean size of esophageal vs gastric varices did not significantly differ (5.3 mm vs 6.1 mm, p ¼ 0.381). The presence of visible varices did not increase the rate of rebleeding (VIS 0.0%, vs NON-VIS 7.9%, p ¼ 0.16) or rate of repeat variceal occlusion interventions (VIS 0.0% vs NON-VIS 7.9%, p ¼ 0.16). Conclusions: Despite procedures to occlude varices, 38.7% of patients had persistent variceal filling on cross-sectional imaging. The presence of visibly filling varices on cross-sectional imaging after TIPS with embolotherapy did not confer a higher risk for rebleeding. The study is limited by few rebleeding events.