The time window for pre-emptive transjugular intrahepatic portosystemic shunt could be extended to 5 days

Area of Science:

• Hepatology
• Interventional Radiology
• Gastroenterology

Background:

• The Baveno VII consensus recommends pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) for acute variceal bleeding (AVB) in cirrhosis.
• The established 72-hour window for pTIPS may be too narrow, necessitating investigation into later intervention timing.

Purpose of the Study:

• To compare clinical outcomes of pTIPS in cirrhotic patients with AVB based on intervention timing: <72 hours versus 72 hours to 5 days.
• To identify independent risk factors for mortality and overt hepatic encephalopathy (OHE) in this patient cohort.

Main Methods:

• Retrospective study of 63 cirrhotic patients with AVB who underwent pTIPS between October 2016 and December 2021.
• Patients were divided into two groups: <72 hours (n=32) and 72 hours-5 days (n=31).
• Kaplan-Meier curves were used to analyze differences in cumulative incidence of death, rebleeding, OHE, and shunt dysfunction.

Main Results:

• No significant differences were observed in cumulative incidence of death (22.3% vs. 19.9%), variceal rebleeding (9.7% vs. 17.8%), OHE (28.5% vs. 23.9%), or shunt dysfunction (8.6% vs. 17.4%) between the <72h and 72h-5d groups.
• Sarcopenia was identified as an independent risk factor for mortality (HR=11.268) and OHE (HR=12.504).

Conclusions:

• The clinical outcomes for cirrhotic patients with AVB undergoing pTIPS within the 72-hour to 5-day window are comparable to those treated within 72 hours.
• Extending the pTIPS intervention window beyond 72 hours may be a viable strategy without compromising patient outcomes.
• Sarcopenia is a significant predictor of adverse outcomes in patients with AVB undergoing pTIPS.