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Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal bleeding.
Am J Gastroenterol. 1998 Jan; 93(1):75-9.AJ

Abstract

OBJECTIVE

Endoscopic sclerotherapy and pharmacological therapy are widely used in the treatment of acute variceal hemorrhage. However, they fail at arresting acute bleeding in 20-30% of bleeding episodes. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of recurrent variceal bleeding has been proved recently, but the effectiveness and safety of urgent TIPS in the treatment of acute variceal bleeding refractory to conventional therapy are still under evaluation.

METHODS

Over 4.5 yr, 358 variceal hemorrhage episodes were treated in our hospital. Pharmacological and endoscopic therapy failed to control hemorrhage in 93 episodes. Thirty-two patients died because of uncontrolled massive bleeding. In 56 patients, TIPS (Strecker stent) was performed after temporary control of the episode with balloon tamponade.

RESULTS

Eleven of 56 patients with urgent TIPS belonged to Child-Pugh class A, 22 to class B, and 23 to class C. The mean time between indication and insertion was 17 +/- 10 h (range 4-24 h). Control of bleeding was achieved in 53 patients (95 %). Eight patients had recurrent bleeding at 1 month after TIPS, seven of them during the first week after the procedure. The 1-month actuarial probability of rebleeding was 22%. The main complications of the procedure were massive hemoperitoneum (n = 1), cardiorespiratory arrest (n = 2), cardiac failure (n = 1), acute renal failure (n = 2), and bacteremia (n = 7). Operative mortality (30 days) was 28%. The actuarial probability of survival at 30 days was significantly lower in Child-Pugh class C than in class A or B (48% vs 90%; p < 0.001). The presence of ascites, hepatic encephalopathy, and serum albumin level before TIPS were independent prognostic factors associated with the risk of operative mortality.

CONCLUSIONS

Urgent TIPS is an effective alternative for the treatment of acute variceal bleeding refractory to endoscopic and pharmacological therapy, but sometimes is associated with major complications. Because of the high operative mortality rate in patients with severe liver failure, careful selection of patients is required before TIPS.

Authors+Show Affiliations

Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.No affiliation info availableNo 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)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9448179

Citation

Bañares, R, et al. "Urgent Transjugular Intrahepatic Portosystemic Shunt for Control of Acute Variceal Bleeding." The American Journal of Gastroenterology, vol. 93, no. 1, 1998, pp. 75-9.
Bañares R, Casado M, Rodríguez-Láiz JM, et al. Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal bleeding. Am J Gastroenterol. 1998;93(1):75-9.
Bañares, R., Casado, M., Rodríguez-Láiz, J. M., Camúñez, F., Matilla, A., Echenagusía, A., Simó, G., Piqueras, B., Clemente, G., & Cos, E. (1998). Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal bleeding. The American Journal of Gastroenterology, 93(1), 75-9.
Bañares R, et al. Urgent Transjugular Intrahepatic Portosystemic Shunt for Control of Acute Variceal Bleeding. Am J Gastroenterol. 1998;93(1):75-9. PubMed PMID: 9448179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal bleeding. AU - Bañares,R, AU - Casado,M, AU - Rodríguez-Láiz,J M, AU - Camúñez,F, AU - Matilla,A, AU - Echenagusía,A, AU - Simó,G, AU - Piqueras,B, AU - Clemente,G, AU - Cos,E, PY - 1998/2/3/pubmed PY - 1998/2/3/medline PY - 1998/2/3/entrez SP - 75 EP - 9 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 93 IS - 1 N2 - OBJECTIVE: Endoscopic sclerotherapy and pharmacological therapy are widely used in the treatment of acute variceal hemorrhage. However, they fail at arresting acute bleeding in 20-30% of bleeding episodes. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of recurrent variceal bleeding has been proved recently, but the effectiveness and safety of urgent TIPS in the treatment of acute variceal bleeding refractory to conventional therapy are still under evaluation. METHODS: Over 4.5 yr, 358 variceal hemorrhage episodes were treated in our hospital. Pharmacological and endoscopic therapy failed to control hemorrhage in 93 episodes. Thirty-two patients died because of uncontrolled massive bleeding. In 56 patients, TIPS (Strecker stent) was performed after temporary control of the episode with balloon tamponade. RESULTS: Eleven of 56 patients with urgent TIPS belonged to Child-Pugh class A, 22 to class B, and 23 to class C. The mean time between indication and insertion was 17 +/- 10 h (range 4-24 h). Control of bleeding was achieved in 53 patients (95 %). Eight patients had recurrent bleeding at 1 month after TIPS, seven of them during the first week after the procedure. The 1-month actuarial probability of rebleeding was 22%. The main complications of the procedure were massive hemoperitoneum (n = 1), cardiorespiratory arrest (n = 2), cardiac failure (n = 1), acute renal failure (n = 2), and bacteremia (n = 7). Operative mortality (30 days) was 28%. The actuarial probability of survival at 30 days was significantly lower in Child-Pugh class C than in class A or B (48% vs 90%; p < 0.001). The presence of ascites, hepatic encephalopathy, and serum albumin level before TIPS were independent prognostic factors associated with the risk of operative mortality. CONCLUSIONS: Urgent TIPS is an effective alternative for the treatment of acute variceal bleeding refractory to endoscopic and pharmacological therapy, but sometimes is associated with major complications. Because of the high operative mortality rate in patients with severe liver failure, careful selection of patients is required before TIPS. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/9448179/Urgent_transjugular_intrahepatic_portosystemic_shunt_for_control_of_acute_variceal_bleeding_ L2 - https://Insights.ovid.com/pubmed?pmid=9448179 DB - PRIME DP - Unbound Medicine ER -