TIPS for portal hypertensive gastropathy bleeding reduces further decompensation and mortality

Background: Portal hypertensive gastropathy (PHG) affects 50-75% of patients with portal hypertension and represents a significant clinical challenge, due to acute and chronic bleeding leading to persistent anemia in up to 26% of patients. PHG-related hemorrhage is typically diffuse and difficult to manage with conventional endoscopic techniques. While transjugular intrahepatic portosystemic shunt (TIPS) has shown benefits in managing variceal bleeding and refractory/recurrent ascites, its role in PHG-related bleeding and subsequent clinical outcomes remains unclear, particularly regarding further decompensation risk.

Aims: This study aims to investigate the effect of TIPS on further decompensation and survival in patients with PHG-related bleeding.

Methods: In this retrospective multicenter study, we identified 81 cirrhotic patients with endoscopically confirmed PHG-related bleeding. Twenty-five patients received TIPS and 56 patients received standard of care (SOC). Using 1:1 propensity score matching, we evaluated the effect of TIPS on further decompensation, specific decompensation events, and survival over 12 months through Kaplan-Meier analysis, Competing risk and Cox proportional hazards regression. Inverse probability of treatment weighting as sensitivity analyses.

Results: TIPS group showed significantly lower rate of further decompensation within 1 year compared to SOC (64% vs. 92%, p=0.017), particularly for (re-)occurrence ascites (24% vs. 64%, p=0.004) and hepatic encephalopathy (HE) (16% vs. 40%, p=0.059). Multivariable Cox regression analysis confirmed as independently associated with lower rates of TIPS ascites (HR: 0.237, 95% CI: 0.087-0.649, p=0.005) and HE (HR: 0.132, 95% CI: 0.025-0.686, p=0.016). TIPS group showed numerically lower rebleeding rates (28% vs. 44%, p=0.239, HR: 0.523, 95% CI: 0.197-1.385, p=0.192). One year mortality showed a trend with TIPS (28% vs. 52%, p=0.083) and significant in overall cohort (28% vs. 57%, p=0.014). IPTW sensitivity analysis confirmed these benefits with even stronger associations, and showed significant reduction in rebleeding risk (HR: 0.573, 95% CI: 0.360-0.913, p=0.019).

Conclusions: TIPS placement in patients with PHG-related bleeding significantly reduces the risk of further decompensation, particularly ascites and HE. These findings suggest that TIPS may serve as a disease-modifying therapy in PHG patients. Larger prospective studies are needed to confirm survival benefits.

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Artikel online veröffentlicht:
04. September 2025