Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding

Zhang, Kai; Sun, Xiaoyan; Wang, Guangchuan; Zhang, Mingyan; Wu, Zhe; Tian, Xiangguo; Zhang, Chunqing

doi:10.1097/md.0000000000015464

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…One retrospective cohort study evaluated 74 cirrhotic patients with gastric variceal bleeding who were treated with either TIPS placement ( n = 31) or percutaneous transhepatic variceal embolization (PTVE). 67 The authors reported no significant differences between the groups in rebleeding or overall survival. Patients treated with PTVE did experience significantly less HE than those with TIPS shunts ( p < 0.0001).…”

Section: Varices With a Splenorenal Shuntmentioning

confidence: 89%

Variceal Hemorrhage: Decompression, Obliteration, or Both?

McCafferty

Khudari

Salei

et al. 2022

Digestive Disease Interventions

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Variceal hemorrhage is a morbid condition that frequently mandates the involvement of interventional radiology to achieve successful and sustained hemostasis. Primary image-guided therapies for variceal hemorrhage include a transjugular intrahepatic portosystemic shunt and transvenous obliteration. Knowledge of variceal pathophysiology and anatomy, current techniques, and the evidence supporting therapeutic selection is paramount to successful patient outcomes. The purpose of this review is to provide the reader a framework of the available literature on image-guided management of bleeding varices to assist in clinical management.

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Section: Varices With a Splenorenal Shuntmentioning

confidence: 89%

Variceal Hemorrhage: Decompression, Obliteration, or Both?

McCafferty

Khudari

Salei

et al. 2022

Digestive Disease Interventions

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“…However, the portosystemic shunt after TIPSS may cause hepatic encephalopathy in CHS patients. 5 PTHVE may be useful to control UGIB. However, the success of PTHVE depends on the condition of hepatic portal vein.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, TIPSS may cause severe hepatic encephalopathy. 5 The embolization of gastroesophageal varices by percutaneous transhepatic portal vein has good hemostatic effect. However, liver deformation and liver lobe disproportion are evident in CHS patients.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Upper Gastrointestinal Bleeding by Percutaneous Transsplenic Varices Embolization in Chronic Hepatic Schistosomiasis Japonicum Patients

Liu

Cai

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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To evaluate percutaneous transsplenic varices embolization (PTSVE) in the treatment of upper gastrointestinal bleeding (UGIB) in patients with chronic hepatic schistosomiasis japonicum (CHS), 29 CHS patients (20 males and 9 females) complicated with UGIB were selected as the investigation subjects. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition, the degrees of varices before and after PTSVE were evaluated by abdominal computed tomography (CT). Results showed that 26 CHS patients (89.6%) were successfully treated with PTSVE. Three cases (10.3%) failed, and two experienced intraperitoneal bleeding within 1 week after PTSVE. The abdominal CT showed a significant decrease of the varices stage in coronary (P < 0.001), esophageal (P = 0.006), and paraesophageal (P = 0.013) varices, but slightly increased perisplenic varices within 1 month of the intervention (P = 0.014). PTSVE may be a safe and effective procedure for the treatment of UGIB in CHS patients, particularly suitable for those with a widened hepatic fissure and exposed hepatic portal vein trunk and an enlarged spleen.

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“…Conventional PTVE was introduced in the 1970s for the treatment of EVB, but it has not attracted su cient attention because of the high rebleeding rate. However, modi ed PTVE with cyanoacrylate started a new chapter in the management of EVB, which has the high hemostasis and low rebleeding rate due to a more extensive obliteration area and permanent embolization of variceal veins than conventional PTVE 16,17 . A study which compared the modi ed PTVE and TIPS revealed that variceal rebleeding rates were comparable (30.2% in TIPS group vs. 20.8% in PTVE group), and PTVE offered lower incidence of encephalopathy than TIPS 18 , and the similar result was a rmed by Zhang et al 16 .…”

Section: Discussionmentioning

confidence: 99%

A creatinine-based model to predict recurrent bleeding after modified percutaneous transhepatic variceal embolization in cirrhotic patients

Li¹,

Zhu

et al. 2020

Preprint

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Background: Patients who survived the initial esophagogastric variceal bleeding (EVB) experienced an increased risk of recurrent bleeding and death, but a reliable predictive model is lacking. We aim to develop and validate a model for rebleeding prediction in cirrhotic patients with EVB after modified percutaneous transhepatic variceal embolization (PTVE) with cyanoacrylate.Methods: A total of 122 patients with EVB who underwent PTVE from January 2015 to March 2020 were enrolled in this study. The multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction. The discrimination, calibration and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease (MELD) and Child–Pugh model. Additionally, a risk stratification was developed according to nomogram.Results: Rebleeding within 3 months after PTVE occurred in 32 patients (26.2%). The independent rebleeding indicators included the history of endoscopic therapy, Child–Pugh score, partial splenic embolization and creatinine level. The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities with a concordance index of 0.85 which was confirmed to be 0.83 through bootstrapping validation. The nomogram harbored better discrimination and clinical applicability than the MELD and Child–Pugh model. As shown in the Kaplan-Meier curves, the patients at high risk were significantly associated with the high probability of rebleeding (P < 0.001). Conclusions: We created a creatinine-based nomogram to predict rebleeding in cirrhotic patients received PTVE, which could help clinicians to discern the high-risk patients to perform more aggressive treatments earlier and formulate intensive follow-up plan for them.

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Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding

Cited by 9 publications

References 29 publications

Variceal Hemorrhage: Decompression, Obliteration, or Both?

Variceal Hemorrhage: Decompression, Obliteration, or Both?

Treatment of Upper Gastrointestinal Bleeding by Percutaneous Transsplenic Varices Embolization in Chronic Hepatic Schistosomiasis Japonicum Patients

A creatinine-based model to predict recurrent bleeding after modified percutaneous transhepatic variceal embolization in cirrhotic patients

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