Use of early-TIPS for high-risk variceal bleeding: Results of a post-RCT surveillance study

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• 作者：Juan Carlos Garcia-Pagá ; n¹ ; ² ; ^&dagger ; ; ^&Dagger ; ; ^{jcgarcia@clinic.ub.es} ; Marco Di Pascoli¹ ; ² ; ^&dagger ; ; ^&Dagger ; ; Karel Caca³ ; ^&dagger ; ; Wim Laleman⁴ ; ^&dagger ; ; Cristophe Bureau⁵ ; ^&dagger ; ; Beate Appenrodt⁶ ; ^&dagger ; ; Angelo Luca⁷ ; ^&dagger ; ; Alexander Zipprich⁸ ; ^&dagger ; ; Juan G. Abraldes¹ ; ² ; ^&dagger ; ; Frederik Nevens⁴ ; ^&dagger ; ; Jean Pierre Vinel⁵ ; ^&dagger ; ; Tilman Sauerbruch⁶ ; ^&dagger ; ; Jaime Bosch¹ ; ² ; ^&dagger ;
• 关键词：AVB ; acute variceal bleeding ; PTFE ; polytetrafluoroethylene ; ET ; endoscopic treatment ; HE ; hepatic encephalopathy ; HVPG ; hepatic venous pressure gradient ; PPG ; portal-venous pressure gradient ; RCT ; randomized international clinical trial ; TIPS ; transjugul
• 刊名：Journal of Hepatology
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：58
• 期：1
• 页码：45-50
• 全文大小：708 K

文摘

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Background & Aims

In a recent randomized international clinical trial (RCT) in high-risk cirrhotic patients with acute variceal bleeding, the early use of transjugular intrahepatic portosystemic shunt (TIPS) was associated with marked and significant reductions in both treatment failure and mortality. The aim of this study was to confirm these results in clinical practice in the same centers of the RCT study.

Methods

We retrospectively reviewed patients admitted for acute variceal bleeding and high risk of treatment failure (Child C <14 or Child B plus active bleeding), treated with early-TIPS (n = 45) or drugs + endoscopic therapy (ET) (n = 30).

Results

Patients treated with early-TIPS had a much lower incidence of failure to control bleeding or rebleeding than patients receiving drug + ET (3 vs. 15; p <0.001). The 1-year actuarial probability of remaining free of this composite end point was 93 % vs. 53 % (p <0.001). The same was observed in mortality (1-year actuarial survival was 86 % vs. 70 % respectively; p = 0.056). Actuarial curves of failure to control bleeding + rebleeding and of survival were well within the confidence intervals of those observed in the RCT.

Conclusions

This study supports the early use of TIPS in patients with cirrhosis and a high-risk variceal bleeding.