PTFE-covered TIPS is an effective treatment for secondary preventing variceal rebleeding in cirrhotic patients with high risks
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY(2020)
摘要
Aim To compare the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) with endoscopic therapy plus non-selective beta-blockers (NSBBs) for secondary prevention of gasroesophageal variceal bleeding (GEVB) in cirrhotic patients with high-risk factors of treatment failure. Methods and material: A total of 122 cirrhotic patients with history of gasroesophageal variceal bleeding and high factors including hepatic vein pressure gradient (HVPG) >= 20 mmHg, portal vein thrombosis (PVT), gastrorenal shunt (GRS), or extraluminal para-gastric veins (ep-GVs) detected by endoscopic ultrasound, were analyzed retrospectively. Seventy-seven patients underwent TIPS with PTFE-covered stent (group A) and 102 patients received endoscopic therapy combined with nonselective beta-blockers (NSBBs) (group B). According to above high-risk factors, both groups were stratified into four paired subgroups (A1-A4 and B1-B4). Two-year rebleeding rate, overt hepatic encephalopathy, overall survival, and procedure-related adverse events were compared between the two groups and paired subgroups. Results: The 2-year cumulative probability of free of variceal rebleeding was higher in group A than group B (93 vs. 62%,P < 0.001). Similarly, the 2-year cumulative probability of free of variceal rebleeding was also higher in the subgroups A1-A4 than the subgroups B1-B4 (91 vs. 67%,P = 0.022, 90 vs. 67%,P = 0.021, 94 vs. 59%,P = 0.029, and 90 vs. 58%,P = 0.016, respectively). There was no significant difference between the two groups and corresponding subgroups in overt hepatic encephalopathy and survival. Conclusion: Compared to secondary prophylaxis with endoscopic therapy plus NSBBs, polytetrafluoroethylene-covered TIPS could significantly reduce the variceal rebleeding rate in cirrhotic patients with HVPG >= 20 mmHg, PVT, GRS, or ep-GVs, without increasing the incidence of hepatic encephalopathy.
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关键词
endoscopic therapy,hepatic encephalopathy,portal hypertension,transjugular intrahepatic portosystemic shunt,variceal bleeding
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