"Salvage" Transjugular Intrahepatic Portosystemic Shunts: Gastric Fundal Compared With Esophageal Variceal Bleeding

Background & Aims: The optimal emergency treatment for gastric fundal variceal bleeding is still unclear. In this study, the efficacy of transjugular intrahepatic portosystemic stent/shunt (TIPS) in patients with uncontrolled gastric fundal vs, esophageal variceal bleeding was compared, Methods: One hundred twelve consecutive patients with uncontrolled variceal bleeding required emergency TIPS, 84 with esophageal varices (EV group) unresponsive to endoscopic and vasoconstrictor therapy and 28 with gastric fundal varices (GV group) unresponsive to vasoconstrictor therapy. Clinical and biochemical data were retrieved, and the two groups were compared. Results: Variceal bleeding was controlled in all patients after TIPS except for 1 in each group. There were no significant differences between the two groups in terms of markers of disease severity, severity of bleeding, or portal hemodynamics. During a median follow-up period of 7 months, 20 in the EV group (24%) and 8 in the GV group (29%) developed clinical rebleeding. Most early rebleeding (within 7 days after TIPS) was related to esophageal ulceration secondary to previous sclerotherapy. Rates of mortality were similar in both groups. Conclusions: These results suggest that emergency TIPS is equally effective in the immediate short-term control of gastric fundal variceal bleeding compared with esophageal variceal bleeding.