Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial
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Summary
This summary is machine-generated.Transjugular intrahepatic portosystemic shunt (TIPS) with covered stents is more effective than endoscopic band ligation plus propranolol for preventing variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This approach also improves PVT resolution without increasing complications.
Area Of Science
- Hepatology
- Interventional Radiology
- Gastroenterology
Background
- Portal vein thrombosis (PVT) complicates cirrhosis, increasing the risk of variceal bleeding.
- Limited data exist on preventing recurrent variceal bleeding in cirrhotic patients with PVT.
Purpose Of The Study
- To compare the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol in preventing variceal rebleeding in patients with cirrhosis and PVT.
Main Methods
- A randomized trial comparing TIPS (n=24) with EBL plus propranolol (n=25) in cirrhotic patients with recent variceal bleeding and PVT.
- Primary endpoint: variceal rebleeding. Secondary endpoints: survival, hepatic encephalopathy, PVT recanalization/rethrombosis, and adverse events.
Main Results
- TIPS significantly reduced variceal rebleeding compared to EBL+propranolol (25% vs 50% at 2 years; HR=0.28, p=0.008).
- TIPS demonstrated higher PVT recanalization (95% vs 70%; p=0.03) and lower rethrombosis rates (5% vs 33%; p=0.06).
- No significant differences in survival or overt hepatic encephalopathy were observed between groups.
Conclusions
- Covered TIPS is more effective than EBL plus propranolol for preventing rebleeding in cirrhotic patients with PVT.
- TIPS facilitates PVT resolution without increasing risks of hepatic encephalopathy or adverse events.
- The improved rebleeding prevention with TIPS did not translate to enhanced survival in this study.