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  • Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

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Hepatobiliary disease
Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial
  1. G Pomier-Layrarguesa,
  2. J-P Villeneuvea,
  3. M Deschênesc,
  4. B Buib,
  5. P Perreaultb,
  6. D Fenyvesa,
  7. B Willemsa,
  8. D Marleaua,
  9. M Bilodeaua,
  10. M Lafortuneb,
  11. M-P Dufresneb
  1. aLiver Unit, Hôpital Saint-Luc, CHUM and Université de Montréal, Montréal, Canada, bRadiology Department, Hôpital Saint-Luc, CHUM and Université de Montréal, Montréal, Canada, cGastroenterology Division, Royal-Victoria Hospital and McGill University, Montréal, Canada
  1. 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

Abstract

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.

METHODS Eighty 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.

RESULTS Mean 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).

CONCLUSIONS TIPS 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.

  • portal hypertension
  • cirrhosis
  • variceal bleeding
  • transjugular intrahepatic portosystemic shunt
  • variceal band ligation

  • Abbreviations used in this paper

    TIPS
    transjugular intrahepatic portosystemic shunt

    • https://doi.org/10.1136/gut.48.3.390

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    • Abbreviations used in this paper

      TIPS
      transjugular intrahepatic portosystemic shunt
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