Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

Abstract

Background and aims-The transjugular intrahepatic portosystemic shunt (TIPS) is a new therapeutic modality for variceal bleeding. In this study we compared the two year survival and rebleeding rates in cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding. Methods-Eighty cirrhotic patients (Pugh score 7-12) with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding. Results-Mean follow up was 581 days in the ligation group and 678 days in the TIPS group. The two year survival rate was 57% in the TIPS group and 56% in the ligation group (NS); the incidence of variceal rebleeding after two years was 18% in the TIPS group and 66% in the ligation group (p<0.001). Uncontrolled rebleeding occurred in 11 patients in the ligation group (eight were rescued by emergency TIPS) but in none of the TIPS group. The incidence of encephalopathy at two years was 47% in the TIPS group and 44% in the ligation group (NS). Conclusions-TIPS did not increase the two year survival rate compared with variceal band ligation after variceal bleeding in cirrhotic patients with moderate or severe liver failure. It significantly reduced the incidence of variceal rebleeding without increasing the rate of encephalopathy. (Gut 2001;48:390-396)

Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: A meta-analysis

“…Overall, 11 randomized trials involving 811 patients [13][14][15][16][23][24][25][26][27][28][29] met the inclusion criteria. Eight were published as full articles in peer-reviewed journals, [13][14][15][16][23][24][25][26] and 3 were published only as abstracts [27][28][29] (Table 2). Agreement between reviewers for the selection of relevant articles was 100%.…”

“…TIPS was compared with sclerotherapy alone in 5 studies, [13][14][15][16]26 with sclerotherapy plus propranolol in 3 studies 23,24,27 (sclerotherapy or ligation plus propranolol in one 23 ), and with ligation alone in 3 studies 25,28,29 (Table 2).…”

“…Moreover, there were 7 (2.2%) of 322 patients randomized to TIPS who were crossed over to ET (Table 5) mainly when TIPS placement was technically unsuccessful 23,25 or even when there was a TIPS failure. 16 Mean or median follow-up was less than 16 months in 6, 14,23,25,[27][28][29] 18 months in 2, 24,26 between 19 and 21 months in 2, 15,16 and 32 months in 1 study 13 (Table 5).…”

Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting

“…The transjugular intrahepatic portosystemic stent shunt (TIPS) is an effective treatment of major complications of portal hypertension, namely variceal hemorrhage (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and refractory ascites (13,14). However, although the rate of recurrent variceal bleeding can successfully be reduced by TIPS insertion, the majority of controlled trials (3)(4)(5)(6)(7)(8)(9)(10) and the meta-analyses (15,16) failed to demonstrate a survival benefit when compared with alternative treatments.…”

“…However, although the rate of recurrent variceal bleeding can successfully be reduced by TIPS insertion, the majority of controlled trials (3)(4)(5)(6)(7)(8)(9)(10) and the meta-analyses (15,16) failed to demonstrate a survival benefit when compared with alternative treatments. This may partly be owing to a reduced portal perfusion after TIPS, which can deteriorate liver function in patients with advanced cirrhosis (11,17).…”