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Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation.
J Hepatol. 2004 Oct; 41(4):560-6.JH

Abstract

BACKGROUND/AIMS

Bleeding ectopic varices due to cirrhosis can be difficult to manage. We report our experience of uncontrolled bleeding from ectopic varices treated with transjugular intrahepatic porto-systemic shunt (TIPS).

METHODS

We selected the 21 cirrhotics who underwent TIPS for bleeding ectopic varices from our database: Child-Pugh grade A (2), B (11) and C (8). Site of bleeding was rectal (11), colonic (2), ileal 1, jejunal 1, duodenal 1, and stomal (5).

RESULTS

TIPS was performed successfully in 19/21 (90%) patients. All except 1 had either a reduction in portosystemic pressure gradient < or = 12 mmHg (n=12) or reduction by 25-50% of baseline (n=6). TIPS alone was used in 12/19: 7 of these 12 had no further bleeding; 5 (42%) rebled within 48 h, and had embolisation, 4 without further bleeding. In 7 of 19, TIPS and embolisation were performed together: 2 patients (28%) rebled; further embolisation stopped the bleeding.

CONCLUSIONS

Ectopic varices do rebleed despite a reduction of porto-systemic pressure gradient < or = 12 mmHg or by 25-50% of baseline, following TIPS. Embolisation stopped bleeding in all but 1 patient. We recommend performing embolisation at the time of the initial TIPS to control bleeding from ectopic varices.

Authors+Show Affiliations

Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital and NHS Hampstead Trust, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15464235

Citation

Vangeli, Marcello, et al. "Bleeding Ectopic Varices--treatment With Transjugular Intrahepatic Porto-systemic Shunt (TIPS) and Embolisation." Journal of Hepatology, vol. 41, no. 4, 2004, pp. 560-6.
Vangeli M, Patch D, Terreni N, et al. Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. J Hepatol. 2004;41(4):560-6.
Vangeli, M., Patch, D., Terreni, N., Tibballs, J., Watkinson, A., Davies, N., & Burroughs, A. K. (2004). Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. Journal of Hepatology, 41(4), 560-6.
Vangeli M, et al. Bleeding Ectopic Varices--treatment With Transjugular Intrahepatic Porto-systemic Shunt (TIPS) and Embolisation. J Hepatol. 2004;41(4):560-6. PubMed PMID: 15464235.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. AU - Vangeli,Marcello, AU - Patch,David, AU - Terreni,Natalia, AU - Tibballs,John, AU - Watkinson,Anthony, AU - Davies,Neil, AU - Burroughs,Andrew Kenneth, PY - 2004/02/09/received PY - 2004/05/30/revised PY - 2004/06/25/accepted PY - 2004/10/7/pubmed PY - 2005/3/4/medline PY - 2004/10/7/entrez SP - 560 EP - 6 JF - Journal of hepatology JO - J. Hepatol. VL - 41 IS - 4 N2 - BACKGROUND/AIMS: Bleeding ectopic varices due to cirrhosis can be difficult to manage. We report our experience of uncontrolled bleeding from ectopic varices treated with transjugular intrahepatic porto-systemic shunt (TIPS). METHODS: We selected the 21 cirrhotics who underwent TIPS for bleeding ectopic varices from our database: Child-Pugh grade A (2), B (11) and C (8). Site of bleeding was rectal (11), colonic (2), ileal 1, jejunal 1, duodenal 1, and stomal (5). RESULTS: TIPS was performed successfully in 19/21 (90%) patients. All except 1 had either a reduction in portosystemic pressure gradient < or = 12 mmHg (n=12) or reduction by 25-50% of baseline (n=6). TIPS alone was used in 12/19: 7 of these 12 had no further bleeding; 5 (42%) rebled within 48 h, and had embolisation, 4 without further bleeding. In 7 of 19, TIPS and embolisation were performed together: 2 patients (28%) rebled; further embolisation stopped the bleeding. CONCLUSIONS: Ectopic varices do rebleed despite a reduction of porto-systemic pressure gradient < or = 12 mmHg or by 25-50% of baseline, following TIPS. Embolisation stopped bleeding in all but 1 patient. We recommend performing embolisation at the time of the initial TIPS to control bleeding from ectopic varices. SN - 0168-8278 UR - https://www.unboundmedicine.com/medline/citation/15464235/Bleeding_ectopic_varices__treatment_with_transjugular_intrahepatic_porto_systemic_shunt__TIPS__and_embolisation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(04)00280-6 DB - PRIME DP - Unbound Medicine ER -