PT  - JOURNAL ARTICLE
AU  - Yong Lv
AU  - Xingshun Qi
AU  - Chuangye He
AU  - Zhengyu Wang
AU  - Zhanxin Yin
AU  - Jing Niu
AU  - Wengang Guo
AU  - Wei Bai
AU  - Hongbo Zhang
AU  - Huahong Xie
AU  - Liping Yao
AU  - Jianhong Wang
AU  - Tao Li
AU  - Qiuhe Wang
AU  - Hui Chen
AU  - Haibo Liu
AU  - Enxing Wang
AU  - Dongdong Xia
AU  - Bohan Luo
AU  - Xiaomei Li
AU  - Jie Yuan
AU  - Na Han
AU  - Ying Zhu
AU  - Jielai Xia
AU  - Hongwei Cai
AU  - Zhiping Yang
AU  - Kaichun Wu
AU  - Daiming Fan
AU  - Guohong Han
ED  - ,
TI  - Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial
AID  - 10.1136/gutjnl-2017-314634
DP  - 2017 Sep 28
TA  - Gut
PG  - gutjnl-2017-314634
4099  - http://gut.bmj.com/content/early/2017/09/28/gutjnl-2017-314634.short
4100  - http://gut.bmj.com/content/early/2017/09/28/gutjnl-2017-314634.full
AB  - Objective Limited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol for the prevention of variceal rebleeding among patients with cirrhosis and PVT.Design Consecutive cirrhotic patients (94% Child-Pugh class A or B) with PVT who had variceal bleeding in the past 6 weeks were randomly assigned to TIPS group (n=24) or EBL plus propranolol group (EBL+drug, n=25), respectively. Primary endpoint was variceal rebleeding. Secondary endpoints included survival, overt hepatic encephalopathy (OHE), portal vein recanalisation and rethrombosis, other complications of portal hypertension and adverse events.Results During a median follow-up of 30 months in both groups, variceal rebleeding was significantly less frequent in the TIPS group (15% vs 45% at 1 year and 25% vs 50% at 2 years, respectively; HR=0.28, 95% CI 0.10 to 0.76, p=0.008), with a significantly higher portal vein recanalisation rate (95% vs 70%; p=0.03) and a relatively lower rethrombosis rate (5% vs 33%; p=0.06) compared with the EBL+drug group. There were no statistically significant differences in survival (67% vs 84%; p=0.152), OHE (25% vs 16%; p=0.440), other complications of portal hypertension and adverse events between groups.Conclusion Covered TIPS placement in patients with PVT and moderately decompensated cirrhosis was more effective than EBL combined with propranolol for the prevention of rebleeding, with a higher probability of PVT resolution without increasing the risk of OHE and adverse effects, but this benefit did not translate into improved survival.Trial registration number ClinicalTrials.gov: NCT01326949.