Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding

Abstract

The safety profile and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS were satisfactory in this small series of children with acute or recurrent gastrointestinal bleeding.

Pediatric Transjugular Intrahepatic Portosystemic Shunts

“…[3][4][5][6][7][8][9] For studies without a preponderance of patients with EHPVO, improved technical success rates are noted, ranging from 78 to 100%. [3][4][5][6][7][8] Type and frequency of complications similarly parallel the adult TIPS data, albeit with a greater need for reintervention in some series. 3,5 Reported complications include intra-and post-procedural bleeding, TIPS thrombosis and stenosis, hepatic encephalopathy, IVC thrombosis, pulmonary edema, perforated roux-en-Y portoenterostomy, and death.…”

“…3,5 Reported complications include intra-and post-procedural bleeding, TIPS thrombosis and stenosis, hepatic encephalopathy, IVC thrombosis, pulmonary edema, perforated roux-en-Y portoenterostomy, and death. [3][4][5][6][7][8][9]33 Following the advent and widespread adoption of partially covered stent-grafts, which now represent the prevailing conduit in pediatric and adult TIPS alike, two studies have demonstrated excellent results. Vo et al reported 100% technical success rate and 100% primary patency rate in 12 patients, with a limited mean follow-up of 40 months (range 4 days to 32 months).…”

“…7 In a similar sized study with longer follow-up, Zurera et al reported 100% technical success rate with two cases of TIPS stenosis at 9 and 54 months, respectively, and two cases of TIPS occlusion at 7 and 12 months, respectively, all of which were successfully managed percutaneously. 8 Lv et al recently described the largest individual series of pediatric TIPSs to date, exclusively describing patients with EHPVO. 9 TIPSs were successfully created in 17 patients, frequently assisted by transhepatic and trans-splenic targeting.…”

“…Despite these perceptions, small retrospective series of pediatric TIPSs provides evidence to the contrary with similar rates of technical and clinical success as well as complications compared with adult series. [3][4][5][6][7][8][9] This nascent but positive experience has begun to influence the pediatric expert consensus, now with increasing support for TIPSs in narrow indications such as esophageal variceal bleeding refractory to pharmacologic and endoscopic management. 10 Reports of pediatric TIPSs performed for other sequelae of portal hypertension, including gastric variceal bleeding, splenic sequestration, ascites, and hepatopulmonary syndrome, have been encouraging, but have received limited or no formal endorsement.…”

Pressure gradients, laboratory changes, and outcomes with transjugular intrahepatic portosystemic shunts in pediatric portal hypertension

“…3 There is a gap in consensus in the role of TIPS in pediatric patients with portal hypertension, 2,5,7 The scope of training for interventional radiologists may lead to relative inexperience in either TIPS or pediatric interventional radiology. 8 While existing results support the use of TIPS in pediatric patients with portal hypertension, 7,[9][10][11][12][13][14][15][16] the currently available case series are small and retrospective, ranging from 1 to 40 patients. 9,[17][18][19][20][21] Recently, Johansen et al published the largest single-center experience in 40 children and adolescents from Birmingham, UK, 21 and again demonstrated safety and effectiveness.…”