Article
Transjugular intrahepatic portosystemic shunt (TIPS) versus
endoscopic variceal ligation in the prevention of variceal rebleeding
in patients with cirrhosis: a randomised trial
G Pomier-Layrarguesa, J-P Villeneuvea, M Deschênesc, B Buib, P Perreaultb, D Fenyvesa, B Willemsa, D Marleaua, M Bilodeaua, M Lafortuneb, M-P Dufresneb
a Liver Unit,
Hôpital Saint-Luc, CHUM and Université de Montréal, Montréal,
Canada, b Radiology Department, Hôpital Saint-Luc, CHUM
and Université de Montréal, Montréal, Canada, c Gastroenterology Division, Royal-Victoria
Hospital and McGill University, Montréal, Canada
Correspondence to: Dr G Pomier-Layrargues, Centre de recherche du CHUM, Hôpital Saint-Luc, 264, East René-Lévesque blvd, Montréal, Québec, Canada H2X 1P1. hepato.saint-luc{at}sympatico.ca
Accepted for publication 5 September 2000
BACKGROUND AND
AIMS
The transjugular intrahepatic portosystemic
shunt (TIPS) is a new therapeutic modality for variceal bleeding. In
this study we compared the two year survival and rebleeding rates in
cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding.
METHODSEighty
cirrhotic patients (Pugh score 7-12) with variceal bleeding were
randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after
control of bleeding.
RESULTSMean follow up
was 581 days in the ligation group and 678 days in the TIPS group. The
two year survival rate was 57% in the TIPS group and 56% in the
ligation group (NS); the incidence of variceal rebleeding after two
years was 18% in the TIPS group and 66% in the ligation group
(p<0.001). Uncontrolled rebleeding occurred in 11 patients in the
ligation group (eight were rescued by emergency TIPS) but in none of
the TIPS group. The incidence of encephalopathy at two years was 47%
in the TIPS group and 44% in the ligation group (NS).
CONCLUSIONSTIPS did
not increase the two year survival rate compared with variceal band
ligation after variceal bleeding in cirrhotic patients with moderate or
severe liver failure. It significantly reduced the incidence of
variceal rebleeding without increasing the rate of encephalopathy.
Keywords: portal hypertension; cirrhosis; variceal bleeding; transjugular intrahepatic portosystemic shunt; variceal band ligation
© 2001 by Gut
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[Abstract] [Full Text] -
BURROUGHS, A K, PATCH, D W, JALAN, R, HAYES, P C
(2001). Management of variceal haemorrhage in cirrhotic patients Reply. Gut
48: 738a-740
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