Preemptive TIPS reduces further decompensation and mortality in gastric variceal hemorrhage

M Kimmann; J A Meier; Z Wang; J Gödiker; S Letmathe; J Chang; C Jansen; C Meyer; M Köhler; K H Peiffer; F E Uschner; B Braden; W Laleman; J Trebicka; J C Garcia Pagan; M Praktiknjo

doi:10.1055/s-0045-1810818

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Z Gastroenterol 2025; 63(08): e475
DOI: 10.1055/s-0045-1810818

Abstracts | DGVS/DGAV

Kurzvorträge

TIPS: Klinischer Verlauf, Outcome und therapeutische Strategien Donnerstag, 18. September 2025, 12:10 – 12:59, Vortragsraum 11

Preemptive TIPS reduces further decompensation and mortality in gastric variceal hemorrhage

Authors

M Kimmann

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
J A Meier

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
Z Wang

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
J Gödiker

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
S Letmathe

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
J Chang

²Department of Medicine I, University Hospital Bonn, Bonn, Deutschland
C Jansen

²Department of Medicine I, University Hospital Bonn, Bonn, Deutschland
C Meyer

³Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Deutschland
M Köhler

⁴Department of Radiology, University Hospital Münster, Münster, Deutschland
K H Peiffer

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
F E Uschner

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
B Braden

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
W Laleman

⁵Department of Liver and Biliary Sciences, University Hospitals Leuven, Leuven, Belgien
J Trebicka

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland
J C Garcia Pagan

⁶Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spanien
M Praktiknjo

¹Department of Medicine B, University Hospital Münster, Münster, Deutschland

Abstract

Volltext

Background: Gastric variceal hemorrhage (GVH) carries a 45% one-year mortality rate and even higher rebleeding risk than esophageal variceal bleeding (30-50% vs. 20-30%). Current guidelines recommend cyanoacrylate injection as first-line treatment, while TIPS is reserved for rescue therapy. However, unlike esophageal variceal bleeding, evidence supporting preemptive TIPS (pTIPS, within 72 hours) for preventing further decompensation and improving survival in GVH remains limited.

Aims: We investigated whether pTIPS could prevent further decompensation and improve survival compared to standard of care (SOC) in patients with GVH.

Method: This multicenter European study retrospectively evaluated cirrhotic patients with acute GVH. From a total cohort of 372 patients, 106 patients were analyzed after 1:1 propensity score matching (53 pTIPS, 53 SOC) based on key clinical parameters. Primary outcome was further decompensation (new or worsening ascites, rebleeding, hepatic encephalopathy （HE）, jaundice, spontaneous bacterial peritonitis, or hepatorenal syndrome-acute kidney injury). Secondary outcomes included mortality, rebleeding, and individual decompensation events over 12 months of follow-up.

Results: After matching, baseline characteristics were well-balanced with Child-Pugh and MELD score of 10 (8, 11) and 14(10, 19), respectively. Preemptive TIPS significantly reduced further decompensation compared to SOC (7.5% vs. 26.4%, p=0.01). In particular, rebleeding (1.9% vs. 22.6%, log-rank p=0.009) and ascites (1.9% vs. 9.4%, log-rank p=0.04) were significantly reduced in the pTIPS group. Moreover, pTIPS significantly reduced 12-month mortality (11.3% vs. 35.8%, log-rank p=0.004). In multivariate logistic regression, TIPS independently prevented further decompensation (OR 0.18, 95% CI 0.047-0.683, p=0.012). Cox regression confirmed TIPS as protective against mortality (HR 0.257, 95% CI 0.099-0.663, p=0.005), rebleeding (HR 0.06, 95% CI 0.008-0.473, p=0.008) and new or worsening of ascites (HR 0.077, 95% CI 0.008-0.709, p=0.024). Multivariate analysis showed no significant difference in HE risk between both groups (HR 1.023, 95% CI 0.474-2.209, p=0.954).

Conclusion: Preemptive TIPS for GVH significantly reduces the rate of further decompensation, in particular rebleeding and new or worsening ascites, which translates into significantly improved survival. The risk of HE was not increased by pTIPS. Our data support the use of pTIPS as first-line therapy for GVH.