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Transjugular intra-hepatic portosystemic shunt for refractory variceal bleeding
T Bizollon1, J Dumortier, C Jouisse
1Hepatology Unit, Hôtel-Dieu, 1 Place de l'Hôpital, 69288 Lyon, France. t.bizollon@wanadoo.fr
Summary
Early transjugular intra-hepatic portosystemic shunt (TIPS) effectively controls refractory esophageal variceal bleeding in cirrhotic patients. This rescue therapy offers improved survival rates, especially when performed early for bleeding unresponsive to other treatments.
Area of Science:
- Hepatology
- Interventional Radiology
- Gastroenterology
Background:
- Esophageal variceal bleeding is a severe complication of portal hypertension in cirrhosis.
- Patients with bleeding unresponsive to medical and endoscopic treatments have a poor prognosis.
Purpose of the Study:
- To evaluate the efficacy of early transjugular intra-hepatic portosystemic shunt (TIPS) in patients with refractory variceal bleeding.
Main Methods:
- TIPS was performed in 28 patients with refractory variceal bleeding (17 Child C).
- The procedure was successful in 26 patients.
- Variceal bleeding was controlled in all but one successfully stented patient.
Main Results:
- No mortality was directly associated with the TIPS procedure itself.
- The 40-day mortality rate was 25%, with deaths attributed to persistent bleeding or multi-organ failure.
- Actuarial survival was 75% at one year and 52% at two years.
- Total bilirubin value was the only independent factor associated with early mortality.
Conclusions:
- Early transjugular intra-hepatic portosystemic shunt (TIPS) serves as an effective rescue therapy for controlling refractory variceal bleeding.
- The procedure demonstrates a significant impact on survival rates in cirrhotic patients with portal hypertension.