The role of the transjugular intrahepatic portosystemic stent-shunt(TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations

Tripathi, Dhiraj; Therapondos, George; Jackson, Edmund S.; Redhead, Doris N.; Hayes, PC

doi:10.1016/s0168-8278(02)80219-7

Cited by 63 publications

(98 citation statements)

References 4 publications

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“…In some series, the initial HVPG in patients with gastric varices was lower than that of patients with esophageal varices, whereas in other series no differences were observed. [81][82][83] In these small series, TIPS was equally effective at controlling bleeding from gastric as well as esophageal varices. [81][82][83][84] Controlled trials comparing surgical shunts or glue in the treatment of these patients would help to better define the role of TIPS in the management of patients with bleeding from gastric varices.…”

Section: Bleeding From Gastric Varicesmentioning

confidence: 78%

“…[81][82][83] In these small series, TIPS was equally effective at controlling bleeding from gastric as well as esophageal varices. [81][82][83][84] Controlled trials comparing surgical shunts or glue in the treatment of these patients would help to better define the role of TIPS in the management of patients with bleeding from gastric varices. In the authors' opinion, TIPS is an important tool in the control of gastric variceal bleeding, though the final portosystemic gradient required to achieve variceal decompression may be lower than what is required for esophageal variceal bleeding, and embolization of the varices also may be required.…”

Section: Bleeding From Gastric Varicesmentioning

confidence: 78%

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The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

2005

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Section: Bleeding From Gastric Varicesmentioning

confidence: 78%

Section: Bleeding From Gastric Varicesmentioning

confidence: 78%

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

2005

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“…However, rebleeding rates have ranged from 20% to 30%. 9 After glue injection for GV, there is erosion of overlying mucosa with extrusion of glue cast over time. Early extrusion, within 1 week, is seen in 12.1% and is associated with early rebleeding in half of these patients (6.2%) with late rebleeding, 2-18 months after injection in only 8.1%.…”

Section: Discussionmentioning

confidence: 99%

“…8 The 5-year survival rate after BRTO is reported to be 85%, 12 whereas that for TIPS has been reported to be 51%. 9 Use of emergency BRTO (within 24 h of UGI bleed) for bleeding GV was studied in 17 consecutive patients. Gastrorenal or gastrocaval shunts were found in all of the 17 patients with complete thrombosis of the GV being achieved with the first BRTO in 10/17 patients and in 6/17 patients with second BRTO performed next day, and the remaining patient had incomplete thrombosis of the varices.…”

mentioning

confidence: 99%

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature

Prajapati

Ranjan

Gupta

et al. 2016

Journal of Clinical and Experimental Hepatology

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Bleeding gastric varices (GV) are managed by cyanoacrylate glue injection with transjugular intrahepatic portosystemic shunt (TIPSS) as modality for treatment failure. Ulcer can form at the site of glue injection over GV and it can cause bleeding. Treatment approach for such bleed is not well described. Balloon-occluded retrograde transvenous obliteration (BRTO), TIPSS, and devascularization remain the treatment options in this scenario. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. BRTO has the benefit of increasing portal hepatic blood flow and can also be useful in patients who may not tolerate TIPSS. We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV. 1 Treatment modalities for bleeding GV are cyanoacrylate glue injection and transjugular intrahepatic portosystemic shunt (TIPSS). Balloon-occluded retrograde transvenous obliteration (BRTO) has been used as a primary treatment for acute bleeding GV. Ulcer can form at the site of glue injection over GV and it can cause bleeding. The exact prevalence of such bleeding and treatment options is not well established. BRTO has been proposed as a possible treatment option in such situation. TIPSS and devascularization remain other therapeutic options in this scenario.BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. BRTO has been used for active GV hemorrhage, which was transiently treated by either endoscopic sclerotherapy or Sengstaken-Blakemore tubes, recent bleeding, and preventive GV obliteration in patients who had never bled.2 Reports of refractory variceal bleed treated with BRTO are rare. 2 We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV. CASE 1A 44-year-old male with Child-Pugh class B cirrhosis presented with UGI bleed. He had past history of glue injection for gastric variceal bleeding one month ago. At admission, the patient had tachycardia (pulse 116/min) and hypotension (BP 86/50 mmHg) pallor. He was resuscitated with crystalloid infusion and blood transfusion and terlipressin infusion was started. After hemodynamic stabilization, he underwent emergent UGI endoscopy which showed small esophageal varices with no stigmata of bleed with large deep white based ulcer over GV at the site of previous glue injection (Figure 1). There was no unsolidified area in the varices for further glue injection. There was ongoing bleeding as indicated by persistent tachycardia and requirement of blood transfusion. Options of TIPSS or BRTO were considered and CT angiography abdomen was done to assess patency of portal vein, hepatic veins, splenic vein, and presence of gastrorenal shunt. CT showed patent portal and splenic veins and a large gastrorenal shunt d...

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“…Fundal varices are the subtype of GVs with highest bleeding and rebleeding rates [39]. Remarkably, large fundal varices may occasionally bleed despite HVPG values less than 12 mmHg [40,41]. Because the blood flow in the GVs is relatively large and the bleeding is rapid and often profuse, endoscopic (EVL, glue, and thrombin) means of treating bleeding GVs are the treatments of choice.…”

Section: Diagnosis and Treatment Of Acute Gastric Variceal Bleedingmentioning

confidence: 99%

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

et al. 2011

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Background Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. MethodsThe expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. Results AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the 123Hepatol Int (2011( ) 5:607-624 DOI 10.1007 AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (\30 min of hospitalization) and endoscopic variceal ligation (door to scope time \6 h) is accepted as first-line therapy. Rebleeding (48 h of T 0 ) is further sub-classified as very early rebleeding (48 to 120 h from T 0 ), early rebleeding (6 to 42 days from T 0 ) and late rebleeding (after 42 days from T 0 ) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of nonresponse to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. Conclusion Management of acute variceal bleeding in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials.

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The role of the transjugular intrahepatic portosystemic stent-shunt(TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations

Cited by 63 publications

References 4 publications

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

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