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Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices.
AJR Am J Roentgenol. 2014 Sep; 203(3):668-73.AA

Abstract

OBJECTIVE

Stomal varices can cause life-threatening gastrointestinal hemorrhage in patients with portal hypertension. Optimal therapy is not well defined. The purpose of this study was to determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for the treatment of hemorrhagic stomal varices.

MATERIALS AND METHODS

All patients who underwent TIPS creation for hemorrhagic stomal varices refractory to medical or endoscopic therapy over a 20-year period (1992-2012) were included. Ten patients (mean age, 63 ± 12 years) were identified. Retrospective chart review was used to document demographic characteristics, procedure details, technical and clinical success, complications, recurrent hemorrhage, and need for repeat interventions. Patients underwent follow-up for an average of 2 years (range, 22 days-9.6 years).

RESULTS

All patients had cirrhosis and portal hypertension. Average corrected sinusoidal pressures were 11 ± 2.4 mm Hg (range, 6-15 mm Hg) before TIPS placement and 4.3 ± 1.8 mm Hg (range, 2-8 mm Hg) after TIPS placement. Five patients (50%) underwent adjunctive embolization of stomal varices through the TIPS, which did not affect outcome. Complications included one patient each with a contrast allergy and renal failure. Six patients experienced complete resolution of bleeding without further intervention (60%). Four patients had recurrent stomal hemorrhage. Two of the four needed TIPS revision for occlusion; one underwent oversewing of the ostomy; and in one the hemorrhage resolved with conservative measures after confirmation of TIPS patency.

CONCLUSION

TIPS creation, with or without adjunctive variceal embolization, is a safe and effective treatment of refractory hemorrhagic stomal varices. Reintervention for recurrent bleeding may be required and appears effective.

Authors+Show Affiliations

1 Division of Vascular and Interventional Radiology, Department of Radiology, New York University Medical Center, 660 First Ave, 7th Fl, New York, NY 10016.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

25148174

Citation

Deipolyi, Amy R., et al. "Reduction in Portal Venous Pressure By Transjugular Intrahepatic Portosystemic Shunt for Treatment of Hemorrhagic Stomal Varices." AJR. American Journal of Roentgenology, vol. 203, no. 3, 2014, pp. 668-73.
Deipolyi AR, Kalva SP, Oklu R, et al. Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices. AJR Am J Roentgenol. 2014;203(3):668-73.
Deipolyi, A. R., Kalva, S. P., Oklu, R., Walker, T. G., Wicky, S., & Ganguli, S. (2014). Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices. AJR. American Journal of Roentgenology, 203(3), 668-73. https://doi.org/10.2214/AJR.13.12211
Deipolyi AR, et al. Reduction in Portal Venous Pressure By Transjugular Intrahepatic Portosystemic Shunt for Treatment of Hemorrhagic Stomal Varices. AJR Am J Roentgenol. 2014;203(3):668-73. PubMed PMID: 25148174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices. AU - Deipolyi,Amy R, AU - Kalva,Sanjeeva P, AU - Oklu,Rahmi, AU - Walker,T Gregory, AU - Wicky,Stephan, AU - Ganguli,Suvranu, PY - 2014/8/23/entrez PY - 2014/8/26/pubmed PY - 2014/10/17/medline KW - TIPS KW - embolization KW - portal hypertension KW - stomal varices KW - transjugular intrahepatic portosystemic shunt SP - 668 EP - 73 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 203 IS - 3 N2 - OBJECTIVE: Stomal varices can cause life-threatening gastrointestinal hemorrhage in patients with portal hypertension. Optimal therapy is not well defined. The purpose of this study was to determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for the treatment of hemorrhagic stomal varices. MATERIALS AND METHODS: All patients who underwent TIPS creation for hemorrhagic stomal varices refractory to medical or endoscopic therapy over a 20-year period (1992-2012) were included. Ten patients (mean age, 63 ± 12 years) were identified. Retrospective chart review was used to document demographic characteristics, procedure details, technical and clinical success, complications, recurrent hemorrhage, and need for repeat interventions. Patients underwent follow-up for an average of 2 years (range, 22 days-9.6 years). RESULTS: All patients had cirrhosis and portal hypertension. Average corrected sinusoidal pressures were 11 ± 2.4 mm Hg (range, 6-15 mm Hg) before TIPS placement and 4.3 ± 1.8 mm Hg (range, 2-8 mm Hg) after TIPS placement. Five patients (50%) underwent adjunctive embolization of stomal varices through the TIPS, which did not affect outcome. Complications included one patient each with a contrast allergy and renal failure. Six patients experienced complete resolution of bleeding without further intervention (60%). Four patients had recurrent stomal hemorrhage. Two of the four needed TIPS revision for occlusion; one underwent oversewing of the ostomy; and in one the hemorrhage resolved with conservative measures after confirmation of TIPS patency. CONCLUSION: TIPS creation, with or without adjunctive variceal embolization, is a safe and effective treatment of refractory hemorrhagic stomal varices. Reintervention for recurrent bleeding may be required and appears effective. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/25148174/Reduction_in_portal_venous_pressure_by_transjugular_intrahepatic_portosystemic_shunt_for_treatment_of_hemorrhagic_stomal_varices_ L2 - https://www.ajronline.org/doi/10.2214/AJR.13.12211 DB - PRIME DP - Unbound Medicine ER -