PS-024-Early TIPS with covered stent versus standard treatment for acute variceal bleeding among patients with advanced cirrhosis: A randomised controlled trial

Lv, Yong; Yang, Zhiping; He, Chuangye; Kai, Li; Wang, Zhengyu; Niu, Jing; Guo, Wengang; Bai, Wei; Zhang, Hongbo; Xie, Huahong; Yao, Liping; Wang, Jianhong; Chen, Hui; Wang, Qiuhe; Yu, Tainlei; Yuan, Xulong; Wang, Enxin; Xia, Dongdong; Luo, Bohan; Li, Xiaomei; Han, Na; Zhu, Ying; Cai, Hongwei; Xia, Jielai; Yin, Zhihua; Wu, Kaichun; Fan, Daiming; Han, Guohong

doi:10.1016/s0618-8278(19)30030-1

Cited by 3 publications

(3 citation statements)

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“…Recent guidelines suggest that patients admitted to, or under observation in, hospital for UGIB undergo endoscopy within 24 h of presentation and in cases of cirrhotic patients with AVB, endoscopic variceal ligation together with vasoactive drugs and antibiotic therapy are recommended 693–695 . 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 696–711 …”

Section: Discussionmentioning

confidence: 99%

“…[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%

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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

111

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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: Discussionmentioning

confidence: 99%

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

111

View full text Add to dashboard Cite

show abstract

“…5,6 However, a relatively large RCT from China was presented at the 2019 International Liver Congress (ILC), Vienna, Austria, and published in abstract form. 7 The key difference between this trial and that of the previous trial of covered stents 6 is the inclusion of patients with Child's B and C cirrhosis without any requirement for active bleeding. Furthermore, active bleeding did not influence the risk of death or transplantation.…”

Section: Updates From the International Liver Congress 2019 (Table 1)mentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS) for Acute Variceal Bleeding: Has it Come of Age?

Tripath

2019

EMJ Hepatol

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The microbiota and the gut–liver axis in primary sclerosing cholangitis

Hov

Karlsen

2022

Nat Rev Gastroenterol Hepatol

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PS-024-Early TIPS with covered stent versus standard treatment for acute variceal bleeding among patients with advanced cirrhosis: A randomised controlled trial

Cited by 3 publications

References 0 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

Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS) for Acute Variceal Bleeding: Has it Come of Age?

The microbiota and the gut–liver axis in primary sclerosing cholangitis

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