Preemptive Transjugular Intrahepatic Portosystemic Shunt in Variceal Bleeding: A Real-World Study in a Tertiary...

Area of Science:

• Hepatology
• Interventional Radiology
• Gastroenterology

Background:

• Variceal bleeding (VB) in cirrhotic patients carries significant morbidity and mortality.
• Early prophylactic transjugular intrahepatic portosystemic shunt (preemptive TIPS) placement is suggested to mitigate these risks.
• Baveno VII guidelines recommend preemptive TIPS within 72 hours for specific high-risk patients.

Purpose of the Study:

• To evaluate the effectiveness of preemptive TIPS compared to a control group in managing variceal bleeding.
• To assess the impact of preemptive TIPS on rebleeding rates and patient survival.
• To analyze the occurrence of hepatic encephalopathy in patients receiving preemptive TIPS.

Main Methods:

• A retrospective analysis of cirrhotic patients with VB was conducted, divided into a control group (no TIPS or TIPS for rebleeding) and a prospective preemptive TIPS (pTIPS) group.
• The control group included patients from 2016-2022, while the pTIPS group included patients from August 2022-January 2024.
• Baseline characteristics, rebleeding rates, survival, and hepatic encephalopathy were compared between groups.

Main Results:

• A total of 47 patients were included: 19 in the pTIPS group and 28 in the control group.
• The pTIPS group exhibited significantly lower early rebleeding rates (5.3% vs. 46.4%, p=0.002).
• No significant differences in 6-week survival (89.5% vs. 89.3%) or hepatic encephalopathy rates were observed between the groups.

Conclusions:

• Preemptive TIPS placement is effective in reducing early rebleeding following variceal bleeding in cirrhotic patients.
• The findings support the proactive integration of preemptive TIPS into clinical practice to lower morbidity.
• While rebleeding is reduced, further research may be needed to fully elucidate long-term survival and complication impacts.