Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding

Rössle, Martin; Deibert, Peter; Haag, K.; Ochs, Andreas; Olchewski, M; Siegerstetter, V.; Kh, Hauenstein; Geiger, Ralf; C, Stiepak; Keller, Wiebke I. Y.; Blum, HE

doi:10.1016/s0140-6736(96)08189-5

Cited by 240 publications

(156 citation statements)

References 24 publications

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“…Our model is similar to the design of clinical trials comparing TIPS with sclerotherapy. [13][14][15][16] A hypothetical cohort of patients with variceal bleeding would be treated with endoscopic sclerotherapy. Subjects who survive and whose variceal bleeding was controlled with endoscopic sclerotherapy would be randomized to sequential endoscopic sclerotherapy, sequential endoscopic ligation, or TIPS and followed for 1 year.…”

Section: Methodsmentioning

confidence: 99%

“…In the base case analysis we assumed that 40% of patients receiving sclerotherapy would experience recurrent variceal bleeding by 1 year (Table 1). [4][5][6][7][8][9][10][11][13][14][15][16] We assumed an annual mortality of 20% for the sclerotherapy arm, with most deaths from recurrent bleeding or liver failure. 10,11,13,15,16 Over the course of a year, 20% of patients would cross over to TIPS because of recurrent variceal bleeding despite undergoing serial endoscopic sclerotherapy sessions.…”

Section: Methodsmentioning

confidence: 99%

“…Most trials comparing TIPS with endoscopic therapy for recurrent variceal bleeding predominantly used sclerotherapy. 10,11,[13][14][15][16] Results from studies comparing ligation with TIPS show higher recurrent bleeding rates with ligation, 40% to 50% versus 10% to 20%, respectively, and higher rates of encephalopathy with TIPS. 12,23 These results are similar to the results comparing TIPS and sclerotherapy.…”

Section: Methodsmentioning

confidence: 99%

“…11,13-16 Although TIPS leads to lower recurrent bleeding rates, it may lead to hepatic encephalopathy. [10][11][12][13][14][15] …”

mentioning

confidence: 99%

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Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding

et al. 2000

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For the prevention of recurrent esophageal variceal bleeding, studies show that patients treated with transjugular intrahepatic portosystemic shunt (TIPS) have lower rebleeding rates compared with endoscopic therapy. However, TIPS is associated with higher rates of portosystemic encephalopathy and possibly higher costs. The aim of this study was to conduct a cost-effectiveness analysis comparing TIPS with endoscopic sclerotherapy and endoscopic ligation for the prevention of recurrent esophageal variceal bleeding. Data for rates of rebleeding, death, complications, and crossover from endoscopy to TIPS were obtained from the literature. Variceal bleeding is a major cause of morbidity and mortality in patients with cirrhosis. Variceal bleeding occurs in 33% of patients with cirrhosis and carries a mortality of 30% to 50%. [1][2][3] Up to 70% of patients have recurrent bleeding within the first year of the first bleeding episode. 1,3 Strategies have been developed for the prevention of recurrent esophageal bleeding in the high-risk group of patients who have had a first bleed.Treatment for acute variceal bleeding includes endoscopic therapy and the transjugular intrahepatic portosystemic shunt (TIPS). Endoscopic sclerotherapy can stop bleeding in 75% to 85% of cases, but recurrent bleeding occurs in 30% to 50% of patients within the first year. 4-9 Studies comparing endoscopic sclerotherapy to endoscopic ligation (banding) show higher rates for controlling bleeding with ligation and lower, but still substantial, recurrent bleeding rates of 26% to 36%. 5,8,9 Twelve percent to 28% of patients undergoing follow-up endoscopy have recurrent variceal bleeding and receive TIPS. [10][11][12][13][14][15][16] TIPS reduces the portosystemic gradient by placing a stent joining the hepatic and portal veins. By reducing portal hypertension, TIPS decompresses varices and prevents recurrent bleeding. Randomized controlled trials comparing TIPS with endoscopic sclerotherapy for recurrent variceal bleeding show that recurrent bleeding rates are 15% to 20% at 1 year, which is 28% to 38% lower than sclerotherapy. 11,13-16 Although TIPS leads to lower recurrent bleeding rates, it may lead to hepatic encephalopathy. [10][11][12][13][14][15]

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…11,13-16 Although TIPS leads to lower recurrent bleeding rates, it may lead to hepatic encephalopathy. [10][11][12][13][14][15] …”

mentioning

confidence: 99%

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Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding

et al. 2000

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“…Several randomized trials, comparing transjugular intrahepatic portosystemic shunt (TIPS) with other therapeutic options, have shown better secondary prevention of gastrointestinal bleeding from oesophageal, gastric and hemorrhoidal portosystemic collaterals with the use of TIPS (2,3). Also effective reduction of refractory ascites is achieved with TIPS (3).…”

mentioning

confidence: 99%

Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

Thijs

Bielen

et al. 2013

Journal of the Belgian Society of Radiology

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The purpose of this article is to review the role of sonography before, during and after transjugular intrahepatic portosystemic shunt placement. A sonographic assessment of the liver and abdomen is recommended before the procedure. We illustrate several important sonographic findings for the echographist, which may alter the procedure approach or even preclude transjugular intrahepatic portosystemic shunt placement. The most challenging step during the procedure is the puncture of the right portal vein. Sonography can be a helpful tool in reducing the number of needle passes, thereby reducing the risk of hemorrhagic complications. Because of its non-invasive and costbenefit nature, sonography is useful for transjugular intrahepatic portosystemic shunt follow-up. A baseline study at 24 to 48 hours is recommended to discover procedure-related complications. Long-term follow-up is important to detect malfunction of the shunt. Doppler ultrasound is very accurate in detecting shunt thrombosis. however, no consensus exists on the optimal sonographic screening protocol for detecting stenosis. We describe three sonographic parameters to detect transjugular intrahepatic portosystemic shunt stenosis with high sensitivity. finally, additional sonographic parameters and potential pitfalls are provided in order to improve sensitivity.

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Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis

Khan

Smith

Williamson

et al. 2006

Cochrane Database of Systematic Reviews

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Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding

Cited by 240 publications

References 24 publications

Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding

Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding

Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis

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