Improved clinical outcome using polytetrafluoroethylene-coated stents for tips: Results of a randomized study

Bureau, Christophe; García-Pagán, Juan Carlos; Otal, Philippe; Pomier‐Layrargues, Gilles; Chabbert, V.; Cortez, Carlos; Perreault, Pierre; Péron, Jean Marie; Abraldes, Juan G.; Bouchard, Louis; Bilbao, J.I.; Bosch, Jaume; Rousseau, Hervé; Vinel, Jean Pierre

doi:10.1053/j.gastro.2003.11.016

Cited by 452 publications

(249 citation statements)

References 25 publications

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“…The advent of covered stents that have been shown to have a lower occlusion rate and lower rates of encephalopathy 133 may increase the enthusiasm for TIPS. However, given past results with surgical shunts, 83 it is likely that TIPS will remain a secondline therapy after endoscopic/pharmacological therapy.…”

Section: E Patients With Cirrhosis Who Have Recovered From Acute Varmentioning

confidence: 99%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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Section: E Patients With Cirrhosis Who Have Recovered From Acute Varmentioning

confidence: 99%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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“…When using coated stents 13% of patients required re-intervention during the first 300 days of a trial (14). We estimated the differences in costs and outcomes for the TIPS cohort when coated stents were theoretically used for all TIPS procedures.…”

Section: Discussionmentioning

confidence: 99%

“…More recently variceal decompression can also be performed less invasively by placing a stent within the liver that connects the portal vein to the hepatic vein (transjugular intrahepatic portosystemic shunt-TIPS) leading to decompression of the entire portal system and prevention of rebleeding (6,(11)(12)(13)(14). Although TIPS may be the preferred approach in compensated and decompensated patients due to availability and efficacy (6,11), it is unknown whether TIPS is as cost effective as shunts.…”

Section: Introductionmentioning

confidence: 99%

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Boyer

Henderson

Heerey

et al. 2008

Journal of Hepatology

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Background and aims-We examined the cost and cost effectiveness of distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of variceal rebleeding. Subjects-Participants in randomized controlled trial comparing DSRS to TIPS.Methods-Quality of life (QOL) measured using SF-36 preceding randomization and yearly thereafter. Cost utility analysis was performed using Data Treeage ®. Costs for both in-and outpatient events and interventions were obtained for each patient. Costs using coated stents were estimated using different rates of stenosis. Incremental cost effectiveness ratios (ICERs) were determined at 1, 3 and 5 years.Results-The average yearly costs of managing patients after TIPS and DSRS over 5 years were similar, $16,363 and $13,492 respectively. Cost of TIPS for surviving patients exceeded the cost of DSRS at years 3 and 5 but not significantly. ICERs per life saved favored TIPS at year 5 ($61,000). If coated rather than bare stents were used the cost-effectiveness of TIPS increased slightly.Conclusions-TIPS is as effective as DSRS in preventing variceal rebleeding and may be more cost effective. TIPS, in all aspects, is equal to DSRS in the prevention of variceal rebleeding in patients who are medical failures.

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“…An increased incidence of HCC in patients with TIPS, however, could lead to drop-outs from the waiting list for liver transplantation if they are not promptly diagnosed. Whether the newly developed polytetrafluoroethylene-covered stent graftswhich have been associated recently with better control of the complications of portal hypertension 25 and better survival 26 -have a similar effect on the risk of developing HCC has not been assessed in our study.…”

Section: Discussionmentioning

confidence: 99%

Patients with cirrhosis and bare-stent TIPS may have increased risk of hepatocellular carcinoma

et al. 2005

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A trend toward a higher incidence of hepatocelullar carcinoma (HCC) in patients with cirrhosis treated with bare-stent transjugular intrahepatic portosystemic shunt (TIPS) has been observed in previous studies. To assess the influence of TIPS as a risk factor for developing HCC, we have compared the incidence of HCC in two retrospective cohorts of patients. The TIPS cohort (n ‫؍‬ 138) included patients with cirrhosis who underwent TIPS placement for the treatment of portal hypertension-related complications; the non-TIPS cohort was composed of patients admitted at the hospital at the same time of TIPS insertion who were individually H epatocellular carcinoma (HCC) is a wellknown complication of cirrhosis. The incidence of this neoplasm has increased worldwide in the last few decades, 1-4 and it currently represents one of the major causes of death in patients with end-stage liver disease. 5 Cirrhosis is considered the major risk factor for developing HCC. 6 Male sex, older age, advanced ChildTurcotte-Pugh class, and viral and alcoholic causes of cirrhosis have been consistently associated with HCC in different studies. 5,7 Other risk factors for developing HCC, however, are not as well defined, due in part to the difficulty of performing epidemiological studies on this condition.Transjugular intrahepatic portosystemic shunt (TIPS) is an invasive procedure in which a side-to-side portacaval shunt is created by placing a stent between the portal vein and a hepatic vein or the cava vein. Because this procedure effectively reduces portal pressure, it is widely used to treat portal hypertensionrelated complications. [8][9][10] A potential association between surgical portosystemic shunting and the development of HCC has been suggested in a retrospective study of autopsies performed on patients who had cirrhosis, 11 but this association has not been confirmed by other studies. 12 Although TIPS is not a surgical shunt, it generates similar circulatory, hemodynamic, and functional changes. As in surgical shunts, two recent preliminary studies have observed higher 13 and unchanged 14 incidence of HCC in patients with noncovered TIPS. Clearly more controlled observations with longer follow-up are needed to better assess the influence of TIPS on the development of HCC. Therefore, we designed a clinical retrospective cohort study to evaluate TIPS as a risk factor for developing HCC. From the

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Improved clinical outcome using polytetrafluoroethylene-coated stents for tips: Results of a randomized study

Cited by 452 publications

References 25 publications

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Patients with cirrhosis and bare-stent TIPS may have increased risk of hepatocellular carcinoma

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