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[Effect of transjugular intrahepatic portosystemic shunt for variceal bleeding in hepatocellular carcinoma patients with portal vein thrombosis].
Korean J Hepatol. 2005 Jun; 11(2):157-63.KJ

Abstract

BACKGROUND/AIMS

Transjugular Intrahepatic Portosystemic Shunt (TIPS) is commonly used in patients with variceal bleeding. However, this procedure is contraindicated in hepatocellular carcinoma patients with portal vein thrombosis. This study was done to evaluate the effect of TIPS in those patients with variceal bleeding.

METHODS

Between 1997 and 2004, six hepatocellular carcinoma (HCC) patients with portal vein thrombosis were enrolled in this study due to their variceal bleeding. All the patients underwent TIPS placement to treat the variceal bleeding that had not responded to endoscopic treatment. Effective shunt creation was assessed by the decrease of the portal pressure gradient (less than 12 mmHg) or if good patency and flow were seen on a doppler examination.

RESULTS

Shunts were successfully created in all the patients and the bleeding was immediately controlled in the active bleeding cases. The bleeding was caused by esophageal varices in one patient and, by gastric varices in five patients. The HCC types were diffuse or massive in five patients, and a single nodule was present in one patient. All the patients had portal vein thrombosis. Rebleeding was noted in two patients at 10 days and 3 months, respectively, due to the shunt occlusion. Hepatic encephalopathy was noted in two patients. The causes of death were hepatorenal syndrome after 2 weeks in one patient, bleeding due to portal hypertensive gastropathy after 3 weeks in another, and cancer progression after 4 months in third patient.

CONCLUSIONS

For HCC patients with portal vein thrombosis, TIPS can be an effective treatment modality if uncontrolled variceal bleeding presents when using endoscopic hemostasis or pharmacologic therapy. However, further studies are needed.

Authors+Show Affiliations

Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea. chung50@dsmc.or.krNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

kor

PubMed ID

15980674

Citation

Chung, Woo Jin, et al. "[Effect of Transjugular Intrahepatic Portosystemic Shunt for Variceal Bleeding in Hepatocellular Carcinoma Patients With Portal Vein Thrombosis]." The Korean Journal of Hepatology, vol. 11, no. 2, 2005, pp. 157-63.
Chung WJ, Jang BK, Park KS, et al. [Effect of transjugular intrahepatic portosystemic shunt for variceal bleeding in hepatocellular carcinoma patients with portal vein thrombosis]. Korean J Hepatol. 2005;11(2):157-63.
Chung, W. J., Jang, B. K., Park, K. S., Cho, K. B., Hwang, J. S., Ahn, S. H., Kim, Y. H., Kim, Y. H., & Kim, Y. J. (2005). [Effect of transjugular intrahepatic portosystemic shunt for variceal bleeding in hepatocellular carcinoma patients with portal vein thrombosis]. The Korean Journal of Hepatology, 11(2), 157-63.
Chung WJ, et al. [Effect of Transjugular Intrahepatic Portosystemic Shunt for Variceal Bleeding in Hepatocellular Carcinoma Patients With Portal Vein Thrombosis]. Korean J Hepatol. 2005;11(2):157-63. PubMed PMID: 15980674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Effect of transjugular intrahepatic portosystemic shunt for variceal bleeding in hepatocellular carcinoma patients with portal vein thrombosis]. AU - Chung,Woo Jin, AU - Jang,Byung Kuk, AU - Park,Kyung Sik, AU - Cho,Kwang Bum, AU - Hwang,Jae Seok, AU - Ahn,Sung Hun, AU - Kim,Yong Hoon, AU - Kim,Young Hwan, AU - Kim,Yong Ju, PY - 2005/6/28/pubmed PY - 2006/4/12/medline PY - 2005/6/28/entrez SP - 157 EP - 63 JF - The Korean journal of hepatology JO - Korean J Hepatol VL - 11 IS - 2 N2 - BACKGROUND/AIMS: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is commonly used in patients with variceal bleeding. However, this procedure is contraindicated in hepatocellular carcinoma patients with portal vein thrombosis. This study was done to evaluate the effect of TIPS in those patients with variceal bleeding. METHODS: Between 1997 and 2004, six hepatocellular carcinoma (HCC) patients with portal vein thrombosis were enrolled in this study due to their variceal bleeding. All the patients underwent TIPS placement to treat the variceal bleeding that had not responded to endoscopic treatment. Effective shunt creation was assessed by the decrease of the portal pressure gradient (less than 12 mmHg) or if good patency and flow were seen on a doppler examination. RESULTS: Shunts were successfully created in all the patients and the bleeding was immediately controlled in the active bleeding cases. The bleeding was caused by esophageal varices in one patient and, by gastric varices in five patients. The HCC types were diffuse or massive in five patients, and a single nodule was present in one patient. All the patients had portal vein thrombosis. Rebleeding was noted in two patients at 10 days and 3 months, respectively, due to the shunt occlusion. Hepatic encephalopathy was noted in two patients. The causes of death were hepatorenal syndrome after 2 weeks in one patient, bleeding due to portal hypertensive gastropathy after 3 weeks in another, and cancer progression after 4 months in third patient. CONCLUSIONS: For HCC patients with portal vein thrombosis, TIPS can be an effective treatment modality if uncontrolled variceal bleeding presents when using endoscopic hemostasis or pharmacologic therapy. However, further studies are needed. SN - 1738-222X UR - https://www.unboundmedicine.com/medline/citation/15980674/[Effect_of_transjugular_intrahepatic_portosystemic_shunt_for_variceal_bleeding_in_hepatocellular_carcinoma_patients_with_portal_vein_thrombosis]_ L2 - https://www.diseaseinfosearch.org/result/5884 DB - PRIME DP - Unbound Medicine ER -