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Transjugular intrahepatic portosystemic shunts in children with biliary atresia
Peter E Huppert1, Pierre Goffette, Wolfgang Astfalk
1Department of Diagnostic Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Strasse 3, D-72076 Tübingen, Germany. PeterHuppert@t-online.de
Insights
Transjugular intrahepatic portosystemic shunts (TIPS) can stop variceal bleeding in children with biliary atresia (BA). However, TIPS procedures in this group are technically challenging and require frequent reinterventions.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Hepatology
Background:
- Portal hypertension in children with biliary atresia (BA) often leads to life-threatening variceal bleeding.
- Transjugular intrahepatic portosystemic shunts (TIPS) are an established treatment for portal hypertension in adults.
Purpose of the Study:
- To evaluate the technical success and long-term clinical outcomes of TIPS in pediatric patients with biliary atresia (BA).
Main Methods:
- Retrospective analysis of nine children with BA and variceal bleeding treated with TIPS.
- Procedures were performed across two centers, with follow-up to assess clinical results and need for reintervention.
Main Results:
- Successful shunt insertion was achieved in all patients, with two requiring a second procedure.
- All patients experienced cessation of variceal bleeding, but eight required 16 reinterventions for restenosis or clinical issues.
- Four patients underwent successful liver transplantation post-TIPS; five remain in good condition long-term.
Conclusions:
- TIPS placement in children with BA is technically demanding due to periportal fibrosis and small portal veins.
- The rate of reintervention after TIPS appears higher in pediatric BA patients compared to adults.
Purpose:
We retrospectively evaluated the technical and long-term clinical results of transjugular intrahepatic portosystemic shunts (TIPS) in children with portal hypertension and biliary atresia (BA).
Methods:
Nine children with BA and recurrent bleeding from esophagogastric and/or intestinal varices were treated by TIPS at the age of 34-156 months and followed-up in two centers. Different types of stents were used.
Results:
Shunt insertion succeeded in all patients, but in two a second procedure was necessary. Seven procedures lasted more than 3 hr, mainly due to difficult portal vein puncture. Variceal bleeding ceased in all patients; however, 16 reinterventions were performed in eight patients for clinical reasons (n = 11) and sonographically suspected restenosis (n = 5). Four patients underwent successful liver transplantation 4-51 months after TIPS and five are in good clinical conditions 64-75 months after TIPS.
Conclusion:
TIPS in children with BA is technically difficult, mainly due to periportal fibrosis and small portal veins. Frequency of reinterventions seems to be higher compared with adults.