PWE-157 Early Tips (transjugular Intrahepatic Portosystemic Shunt) For Acute Variceal Bleeding Complicating Alcoholic Hepatitis (ah)

Abstract

ConclusionThe complication rate does not significantly increase with increasingly deranged coagulation. This is despite very low usage of FFP in this study. There is a trend towards an increased risk of bloodstaining and hypotension in the high INR group, which does not achieve statistical significance. Disclosure of Interest None Declared. Introduction Patients with chronic liver disease have several unplanned admissions during their disease trajectory. 1 We undertook a service improvement initiative to develop a new care pathway for patients with ASLD. Methods Six month pilot of 20 ASLD patients, (≥ 2admissions in last 12 months/'would you be surprised question' with 6-12 mths prognosis/Childs C). Team of hepatologist, community matron, hepatology nurse specialist and service improvement facilitator developed 'Durham Metrics': quantitative and qualitative metrics ( Figure) to evaluate ASLD pathway, on best practice, 2 further refined with focussed discussion with stakehoders. Results The metrics demonstrated that patient expereince prepilot was poor with multiple unplanned admissions and/or long waits, preferred place of death was not discussed; care was not co-ordinated, and quality of life was often poor as a result. All post-pilot metrics reported significant improvements. Use of alternative community services, and shared care plans led to improved efficiency. 83% achieved their preferred place of care and death contrast to nil pre pilot. PWE-156 DURHAM METRICS TO EVALUATE EFFECTIVENESS OFConclusion Key metrics of performance are essential to evaluate service improvement project. The project metrics designed for this project were able to capture changes initiated by pathway however more data and time is needed to draw statistically valid conclusions. Introduction The ideal management of variceal bleeding in the setting of acute alcoholic hepatitis is unclear. We present the outcome of this subgroup of patients in a cohort of patients treated with primary TIPS for variceal bleeding. Methods A retrospective analysis on patients who had TIPS procedure performed as a primary treatment modality within 72 h of acute variceal bleeding from December 2010 to April 2013 with a minimum of 6 months follow up was performed. Results 56 patients were included into the final analysis. In AH patients (n = 18) mean age was 48 years (30-65), mean discriminant function (DF) was 51 (24-87) and mean MELD score was 22. The 6 month mortality was 50%(9/18) with (7/9) dying within 30 days. The median HVPG (mmHg) pre-TIPS and post-TIPS were 16.5 and 6.5 respectively. In non-AH patient (n = 38) average age was 51y (25-70) mean MELD score was 14 (22-7). The mortality was 13% (5/38) at 6 months, (3/5) died by day 30. The median HVPG (mmHg) pre-TIPS and post-TIPS was 23 and 10 respectively. Conclusion In patients with variceal bleeding complicating AH there is a higher 30 day and 6 month mortality in patients managed with a primary TIPS in comparison to patients with cirrhosis. The ideal management of this complex group remains unclear...

The role of pre-emptive Transjugular Intrahepatic Portosystemic Shunt in acute variceal bleeding: a literature review

“…This point was addressed in a UK-based single-centre experience published as an abstract in 2014. 30 Analysis of 54 patients who received pre-emptive TIPSS as intention to treat showed that the AH subgroup had higher average MELD scores, higher HVPG measurements (preand post-TIPSS) and higher mortality (50% versus 13% at 6 months) compared with non-AH patients undergoing pre-emptive TIPSS. However, this study lacked comparison with AH patients not receiving pre-emptive TIPSS, and therefore it is difficult to conclude the applicability of pre-emptive TIPSS in these patients.…”

PWE-157 Early Tips (transjugular Intrahepatic Portosystemic Shunt) For Acute Variceal Bleeding Complicating Alcoholic Hepatitis (ah)

“…Introduction Patients with chronic liver disease have several unplanned admissions during their disease trajectory. 1 We undertook a service improvement initiative to develop a new care pathway for patients with ASLD. Methods Six month pilot of 20 ASLD patients, (≥ 2admissions in last 12 months/'would you be surprised question' with 6-12 mths prognosis/Childs C).…”