Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Therapy in the Secondary Prophylaxis of Variceal Rebleeding in Cirrhotic Patients

Zheng, Ming‐Hua; Chen, Yongping; Bai, Jianling; Zeng, Qian; You, Jie; Jin, Rong; Zhou, Xiaosa; Shen, Hong; Zheng, Yi; Du, Zhou

doi:10.1097/mcg.0b013e31815576e6

Cited by 130 publications

(75 citation statements)

References 30 publications

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“…First-line therapy (FLT) is based on both NSBBs and EVL. RCT comparing TIPS to FLT, even if inhomogeneous, agreed that TIPS is highly effective in preventing rebleeding, although with a significantly burden of HE, but it did not improve overall mortality [107][108][109].…”

Section: Tips Is Not Indicated For the Prophylaxis Of First Variceal mentioning

confidence: 99%

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

124

120

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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Section: Tips Is Not Indicated For the Prophylaxis Of First Variceal mentioning

confidence: 99%

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

124

120

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“…Jego zastosowanie powinno być ograniczone do sytuacji, gdy pozostałe metody leczenia okazały się nieskuteczne [127]. Leczenie za pomocą TIPS wiąże się ze zmniejszeniem częstości wystąpienia nawrotów krwawienia i śmiertelności zwią-zanej z krwawieniem, natomiast zwiększa częstość występowania encefalopatii [132]. Wewnątrzwątrobowe zespolenie wrotno-systemowe jest skuteczną i preferowaną metodą leczenia w profilaktyce nawrotu krwawienia z żylaków żołądka [127].…”

Section: Przezżylne śRódwątrobowe Zespolenia Wrotno-systemoweunclassified

Management of variceal haemorrhage

Wróblewski¹,

Dâbrowski²

2010

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StreszczenieŻylaki przełyku są bardzo poważnym powikłaniem nadciśnie-nia wrotnego, którego najczęstszą przyczyną jest marskość wątroby. Krwawienie z żylaków przełyku często ma dramatyczny przebieg, może nawracać i wiąże się ze znaczną śmier-telnością. Dzięki aktualnie stosowanym metodom leczenia śmiertelność związana z krwawieniem w ostatnich 2 dekadach zmniejszyła się o połowę, z 40% do ok. 20%. Stało się tak dzięki lepszemu zrozumieniu mechanizmów prowadzą-cych do wzrostu ciśnienia wrotnego oraz udoskonaleniu metod leczenia farmakologicznego, endoskopowego i radiologicznego. Nowoczesne leczenie krwawienia z żylaków przełyku powinno uwzględnić miejsce jego prowadzenia -oddział intensywnego nadzoru, ostrożną stabilizację hemodynamiczną, skuteczne leczenie zakażenia, zastosowanie leków obniżających ciśnienie wrotne. Kluczową rolę odgrywa terapia endoskopowa, gdzie metodą z wyboru jest opaskowanie, a alternatywą skleroterapia. Istotne znaczenie ma profilaktyka nawrotu krwawienia oraz profilaktyka pierwszego krwawienia. W przypadku niepowodzenia leczenia endoskopowego i farmakologicznego alternatywą jest TIPS (transjugular porto-systemic shunt) i dotyczy to zarówno leczenia ostrego krwawienia, jak i profilaktyki wtórnej. AbstractOesophageal varices are a very severe complication of portal hypertension which is mainly caused by hepatic cirrhosis. Variceal bleeding often has a dramatic course, may recur and is associated with substantial mortality. Thanks to the currently used methods of treatment, in the last two decades the mortality rate due to bleeding has decreased by half, from 40 to 20%. This was possible owing to better understanding of the mechanisms that cause an increase in portal hypertension, and thanks to improvement in pharmacological, endoscopic and radiological treatments. The modern management of oesophageal variceal bleeding should take into consideration the place of treatment -the intensive care unit, cautious haemodynamic stabilization, effective treatment of infection and administration of drugs reducing portal pressure. Endoscopic therapy plays a fundamental role, with variceal band ligation being the treatment of choice and injection sclerotherapy as an alternative option. Very important are rebleeding prevention and primary bleeding prophylaxis. When endoscopic and pharmacological treatments fail, transjugular porto-systemic shunt (TIPS) is an alternative both for the treatment of acute bleeding and as secondary prophylaxis. WprowadzenieŻylaki przełyku są częstym i bardzo groźnym powikła-niem nadciśnienia wrotnego, które cechuje się wzrostem ciśnienia w obrębie żyły wrotnej powyżej 12 mm Hg. Ponieważ bezpośredni pomiar ciśnienia w żyle wrotnej oraz określenie prawidłowego zakresu ciśnień w układzie wrotnym są trudne, jako kryterium nadciśnienia wrotnego przyjmuje się gradient ciśnień między żyłą wrotną a żyłą główną dolną (ang. hepatic venous pressure gradient -HVPG) większy niż 5-10 mm Hg. Najczęstszą przyczyną nadciśnienia wrotnego, bo aż w ok. 90% przypadków, jest marskość wątroby (klasyf...

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“…TIPSS is performed by specialist interventional radiologists, and has been shown to be superior to VBL for preventing rebleeding (19.0% vs 43.8%, OR 0.32, 95% CI 0.24-0.43, p < 0.00001), but with increased rate of post-procedural encephalopathy (OR 2.21, 95% CI 1.61-3.03, p < 0.00001). 82 Contraindications to TIPSS are summarised in Table 3. 83 For those with anatomical contraindications, shunt surgery may be considered.…”

Section: Transjugular Intrahepatic Portosystemic Shunt (Tipss) and Rementioning

confidence: 99%

Management of Acute Upper Gastrointestinal Bleeding: An Update for the General Physician

Siau

Chapman

Sharma

et al. 2017

Journal of the Royal College of Physicians of Edinburgh

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Acute upper gastrointestinal bleed (AUGIB) is one of the most common medical emergencies in the UK, with roughly one presentation every 6 min. Despite advances in therapeutics and endoscopy provision, mortality following AUGIB over the last two decades has remained high, with over 9,000 deaths annually in the UK; consequently, several national bodies have published UKrelevant guidelines. Despite this, the 2015 UK National Con dential Enquiry into Patient Outcome and Death in AUGIB highlighted variations in practice, raised concerns regarding suboptimal patient care and released a series of recommendations. This review paper incorporates the latest available evidence and UK-relevant guidelines to summarise the optimal pre-endoscopic, endoscopic, and post-endoscopic approach to and management of non-variceal and variceal AUGIB that will be of practical value to both general physicians and gastroenterologists.

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Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Therapy in the Secondary Prophylaxis of Variceal Rebleeding in Cirrhotic Patients

Abstract: TIPS is currently the first choice to prevent rebleeding except that TIPS is worse than endoscopic therapy for encephalopathy. An exploration of new approaches out of above complications will be of considerable clinical significance and be a challenge to clinicians.

Cited by 130 publications

References 30 publications

Consensus conference on TIPS management: Techniques, indications, contraindications

Consensus conference on TIPS management: Techniques, indications, contraindications

Management of variceal haemorrhage

Management of Acute Upper Gastrointestinal Bleeding: An Update for the General Physician

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