Endoscopic therapy + β-blocker vs. covered transjugular intrahepatic portosystemic shunt for prevention of variceal rebleeding in cirrhotic patients with hepatic venous pressure gradient ≥16 mmHg

Abstract

Background and objective Currently, monitoring hepatic venous pressure gradient (HVPG) have been proved to be the best predictor for the risk of variceal bleeding. We performed the study to evaluate the effect of endoscopic therapy + β-blocker vs. covered transjugular intrahepatic portosystemic shunt (TIPS) for the prevention of variceal rebleeding in cirrhotic patients with HVPG ≥16 mmHg. Methods Consecutive cirrhotic patients with HVPG ≥16 mmHg treated with endoscopic therapy + β-blocker or covered TIPS for variceal bleeding were retrospectively gathered between April 2013 and December 2018. The variceal rebleeding rate, survival, and incidence of overt hepatic encephalopathy (OHE) were compared. Results A total of 83 patients were analyzed, of which 46 received endoscopic therapy + β-blocker and 37 covered TIPS. During a median follow-up of 12.0 months, the rebleeding rate (32.6 vs. 10.8%, P = 0.017) and rate of OHE (2.2 vs. 27.0%, P = 0.001) showed significant differences between the two groups, while liver transplantation-free survival (93.5 vs. 94.6%, P = 0.801) was similar. Preoperative and postoperative Child-Turcotte-Pugh scores were similar in either group. In addition, no significant differences of rebleeding rate (25.0 vs. 21.3%, P = 0.484) and survival (97.2 vs. 91.5%, P = 0.282) were observed between patients with 16 mmHg ≤ HVPG < 20 mmHg and HVPG ≥ 20 mmHg. Conclusion Covered TIPS was more effective than endoscopic therapy + β-blocker in preventing rebleeding in patients with HVPG ≥16 mmHg but did not improve survival. TIPS also induce more OHE.

Covered Transjugular Intrahepatic Portosystemic Shunt improves survival for variceal Bleeding in cirrhotic patients with hepatic venous pressure gradient≥16 mmHg: A a comparison study

“…Moreover, HVPG ≥ 20 mmHg has been a clinically effective predictor of early rebleeding [11] . In our previous study [12] , During a 1-year follow-up time, we concluded that covered TIPS was more effective than standard therapy in preventing rebleeding but that it did not improve survival.…”

“…Finally we included 184 patients in our study. Eighty-three of the 184 patients have been previously reported [12] . The prior article examined the effect of covered TIPS vs. endoscopic therapy+β-blockers in patients with HVPG≥16 mmHg at a 1-year follow-up, whereas in this study, which included all patients with HVPG≥10 mmHg, we report on the long-term outcome after covered TIPS therapy.…”

“…Endoscopic therapy and the NSBBs usage was same as our previous article [12] , which was described speci cly in complementary les.…”

Covered TIPS Procedure-Related Major Complications: Incidence, Management and Outcome From a Single Center

“…All the procedures were completed by 2–3 experienced gastroenterology intervention doctors in this institution. The process of the TIPS procedure has been described in detail in previous articles ( 9 ). Briefly, the right or middle hepatic vein was catheterized using a transjugular venous approach with RUPS-100 (COOK; Indiana, United States) under local anesthesia.…”

A 65-year-old man with melena and a blood disorder

“…It should be therefore reserved for select cases. 26 In the setting of bleeding esophageal varices, the ideal candidate for shunt placement within the first 3 days of presentation would have no history of hepatic encephalopathy, no history of heart failure or tricuspid valve regurgitation, no signs of sepsis, no pulmonary hypertension, and no significant coagulopathy.…”