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Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage.
Hepatology. 1999 Jan; 29(1):27-32.Hep

Abstract

Variceal hemorrhage continues to be a major cause of morbidity and mortality in cirrhotic patients. Transjugular intrahepatic portosystemic shunt (TIPS) is gaining wide acceptance as a treatment for several complications of portal hypertension. The aim of the current randomized study was to compare the transjugular shunt and endoscopic sclerotherapy (ES) for the prevention of variceal rebleeding (VB) in cirrhotic patients. Forty-six consecutive cirrhotic patients with variceal bleeding were randomly allocated to receive either transjugular shunt (22 patients) or ES (24 patients) 24 hours after control of bleeding. VB (50% vs. 9%) and early (first 6 weeks) VB (33% vs. 5%) were significantly more frequent in sclerotherapy patients; the actuarial probability of being free of VB was higher in the shunt group (P <.002). Eight patients (33%) of the sclerotherapy group and 3 patients (15%) of the shunt group died; the actuarial probability of survival was higher for the shunted patients (P <.05); 6 patients in the sclerotherapy group and none in the shunt group died from VB (P <.05). No difference was found in the proportion of patients with clinically evident hepatic encephalopathy (HE). These results show that the transjugular shunt is more effective than sclerotherapy in the prevention of both early and long-term VB. Moreover, a significant improvement in survival was found in the shunt group.

Authors+Show Affiliations

Service of Digestive Disorders, Hospital Insular Universitario, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.lgarcia@medynet.comNo 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)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9862845

Citation

García-Villarreal, L, et al. "Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Sclerotherapy for the Prevention of Variceal Rebleeding After Recent Variceal Hemorrhage." Hepatology (Baltimore, Md.), vol. 29, no. 1, 1999, pp. 27-32.
García-Villarreal L, Martínez-Lagares F, Sierra A, et al. Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage. Hepatology. 1999;29(1):27-32.
García-Villarreal, L., Martínez-Lagares, F., Sierra, A., Guevara, C., Marrero, J. M., Jiménez, E., Monescillo, A., Hernández-Cabrero, T., Alonso, J. M., & Fuentes, R. (1999). Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage. Hepatology (Baltimore, Md.), 29(1), 27-32.
García-Villarreal L, et al. Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Sclerotherapy for the Prevention of Variceal Rebleeding After Recent Variceal Hemorrhage. Hepatology. 1999;29(1):27-32. PubMed PMID: 9862845.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage. AU - García-Villarreal,L, AU - Martínez-Lagares,F, AU - Sierra,A, AU - Guevara,C, AU - Marrero,J M, AU - Jiménez,E, AU - Monescillo,A, AU - Hernández-Cabrero,T, AU - Alonso,J M, AU - Fuentes,R, PY - 1998/12/24/pubmed PY - 1998/12/24/medline PY - 1998/12/24/entrez SP - 27 EP - 32 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 29 IS - 1 N2 - Variceal hemorrhage continues to be a major cause of morbidity and mortality in cirrhotic patients. Transjugular intrahepatic portosystemic shunt (TIPS) is gaining wide acceptance as a treatment for several complications of portal hypertension. The aim of the current randomized study was to compare the transjugular shunt and endoscopic sclerotherapy (ES) for the prevention of variceal rebleeding (VB) in cirrhotic patients. Forty-six consecutive cirrhotic patients with variceal bleeding were randomly allocated to receive either transjugular shunt (22 patients) or ES (24 patients) 24 hours after control of bleeding. VB (50% vs. 9%) and early (first 6 weeks) VB (33% vs. 5%) were significantly more frequent in sclerotherapy patients; the actuarial probability of being free of VB was higher in the shunt group (P <.002). Eight patients (33%) of the sclerotherapy group and 3 patients (15%) of the shunt group died; the actuarial probability of survival was higher for the shunted patients (P <.05); 6 patients in the sclerotherapy group and none in the shunt group died from VB (P <.05). No difference was found in the proportion of patients with clinically evident hepatic encephalopathy (HE). These results show that the transjugular shunt is more effective than sclerotherapy in the prevention of both early and long-term VB. Moreover, a significant improvement in survival was found in the shunt group. SN - 0270-9139 UR - https://www.unboundmedicine.com/medline/citation/9862845/Transjugular_intrahepatic_portosystemic_shunt_versus_endoscopic_sclerotherapy_for_the_prevention_of_variceal_rebleeding_after_recent_variceal_hemorrhage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S027091399900004X DB - PRIME DP - Unbound Medicine ER -