Z Gastroenterol 2015; 53 - P81
DOI: 10.1055/s-0035-1551769

Efficacy of transjugular intrahepatic portosystemic shunts (TIPS) for controlling variceal bleeding in patients with cirrhosis and portal hypertension

T Bucsics 1, 2, M Diermayr 1, 2, M Feldner-Busztin 1, 2, P Schwabl 1, 2, M Mandorfer 1, 2, F Karnel 3, J Karner 4, B Angermayr 1, M Cejna 5, W Sieghart 1, 2, A Ferlitsch 1, 2, M Peck-Radosavljevic 1, 2, T Reiberger 1, 2
  • 1Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
  • 2Medizinische Universität Wien, Vienna Hepatic Hemodynamic Laboratory, Wien, Austria
  • 3Sozialmedizinisches Zentrum Süd – Kaiser-Franz-Josef-Spital, Abteilung für interventionelle Radiologie, Wien, Austria
  • 4Sozialmedizinisches Zentrum Süd – Kaiser-Franz-Josef-Spital, Abteilung für Chirurgie, Wien, Austria
  • 5Abteilung für Radiologie, Landeskrankenhaus Feldkirch, Feldkirch, Austria

Background and aims:

Transjugular intrahepatic portosystemic shunt (TIPS) is used to control severe variceal bleeding (“early TIPS”) or for secondary failure to control bleeding in patients with liver cirrhosis and portal hypertension. The aim of this study was to evaluate the efficacy of to control variceal (re)bleeding.

Patients and Methods:

In this retrospective cohort study, all adult patients undergoing TIPS implantation for the indication of variceal bleeding in two major centres in Vienna between 01.01.1994 and 31.08.2014 were included. Clinical endpoints (variceal bleeding, hepatic encephalopathy, orthotopic liver transplantation) and death were recorded from medical histories.

Results:

Overall, 311 patients were included. Bleeding events occurred in 25% (n = 79) after TIPS implantation and were more common in bare-metal stents than in ePTFE stents (32% vs. 17%; p = 0.002). Although West Haven III-IV hepatic encephalopathy occurred more frequently in the ePTFE group (49% vs. 35%; p = 0.028), 1-year transplant-free survival was significantly higher (ePTFE 86% vs. bare metal 75%; p = 0.015). Portal pressure gradient after TIPS implantation was similar between patients with subsequent rebleeding vs. non-rebleeders (8.7 ± 3.5 mmHg vs. 8.0 ± mmHg; p = 0.352). Isolated oesophageal varices had the highest risk for rebleeding (31%, n = 63/203), while patients with isolated gastric varices did not re-bleed (n = 0/11).

Conclusions:

In this study, TIPS prevented variceal re-bleeding in 75% of all patients, being particularly effective in isolated gastric varices (0% re-bleeding). As expected, ePTFE stents were more effective in the prevention of variceal re-beeding than bare metal stents.