RT Journal Article
SR Electronic
T1 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
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP gutjnl-2017-314634
DO 10.1136/gutjnl-2017-314634
A1 Yong Lv
A1 Xingshun Qi
A1 Chuangye He
A1 Zhengyu Wang
A1 Zhanxin Yin
A1 Jing Niu
A1 Wengang Guo
A1 Wei Bai
A1 Hongbo Zhang
A1 Huahong Xie
A1 Liping Yao
A1 Jianhong Wang
A1 Tao Li
A1 Qiuhe Wang
A1 Hui Chen
A1 Haibo Liu
A1 Enxing Wang
A1 Dongdong Xia
A1 Bohan Luo
A1 Xiaomei Li
A1 Jie Yuan
A1 Na Han
A1 Ying Zhu
A1 Jielai Xia
A1 Hongwei Cai
A1 Zhiping Yang
A1 Kaichun Wu
A1 Daiming Fan
A1 Guohong Han
A1 ,
YR 2017
UL http://gut.bmj.com/content/early/2017/09/28/gutjnl-2017-314634.abstract
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.