Glue Embolization of Gastroesophageal Varices during Transjugular Intrahepatic Portosystemic Shunt (TIPS) Improves Survival Compared to Coil-only Embolization—A Single-Center Retrospective Study

Abstract

Purpose To compare the safety and effectiveness of coil versus glue embolization of gastroesophageal varices during transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods In this monocentric retrospective study 104 (males: 67 (64%)) patients receiving TIPS with concomitant embolization of GEV and a minimum follow-up of one year (2008—2017) were included. Primary outcome parameter was overall survival (6 week; 1 year). Six-week overall survival was assessed as a surrogate for treatment failure as proposed by the international Baveno working group. Secondary outcome parameters were development of acute-on-chronic liver failure (ACLF), variceal rebleeding and hepatic encephalopathy (HE). Survival analysis was performed using Kaplan–Meier with log-rank test and adjusted Cox regression analysis. Results Indications for TIPS were refractory ascites (n = 33) or variceal bleeding (n = 71). Embolization was performed using glue with or without coils (n = 40) (Group G) or coil-only (n = 64) (Group NG). Overall survival was significantly better in group G (p = 0.022; HR = -3.333). Six-week survival was significantly lower in group NG (p = 0.014; HR = 6.945). Rates of development of ACLF were significantly higher in group NG after 6 months (NG = 14; G = 6; p = 0.039; HR = 3.243). Rebleeding rates (NG = 6; G = 3; p = 0.74) and development of HE (NG = 22; G = 15; p = 0.75) did not differ significantly between groups. Conclusion Usage of glue in embolization of GEV may improve overall survival, reduce treatment failure and may be preferable over coil embolization alone.

Comparison of Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Cirrhosis With or Without Portal Vein Thrombosis: A Retrospective Study

“…Our study reveals that the usage of glue in PTVE may improve overall survival and prevent shunt dysfunction, which may be preferable over coil embolization alone. This finding was consistent with the results of a recent study ( 32 ). One explanation for this finding may be that, due to the physical properties of the glue embolization material, it may propagate more readily and thoroughly into the network of PTVE, thus, leading to a cast-like formation accumulating in the periphery of PTVE.…”

Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study

“…39 In considering the materials used for embolisation, existing studies suggest that using vascular plugs, coils or tissue glue showed similar outcomes in terms of rebleeding and mortality, while the combination of coils and tissue glue may enhance survival at the cost of increased hospitalisation expenses. [40][41][42] An interesting nuance arises from variations between Western and Eastern practices in the sequencing of TIPS and embolisation. 25 This discrepancy may influence PPG and subsequently impact rebleeding and HE.…”

Reply

“…Indeed, a recent single-center retrospective study showed that glue embolization of gastroesophageal varices during TIPS improves survival compared to coil-only embolization. [5] Nevertheless, no liquid embolic material was used in our study, and a direct comparison to coil embolization was impossible. Thus, whether BRTO is superior to coil embolization of large SPSS during TIPS for the prevention of post-TIPS HE in patients with cirrhosis merits further investigation.…”