ISSN:
1573-2568
Keywords:
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
;
SCLEROTHERAPY
;
CIRRHOSIS
;
PORTAL HYPERTENSION
;
VARICEAL BLEEDING
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Nonsurgical reduction of portal hypertension bytransjugular intrahepatic portosystemic shunt (TIPS) iswidely used for prevention of variceal rebleeding(elective TIPS). Information is limited about the value of emergency TIPS for acute varicealbleeding unresponsive to endoscopic and drug therapy.The aim of the present study was therefore to determinewhether the effects and complications differ between emergency and elective TIPS in patients withcirrhosis of the liver. TIPS was performed in 11patients with acute variceal bleeding unresponsive toendoscopic treatment and 22 patients in stable condition after an episode of variceal bleeding. Clinicalexamination, blood sampling, Doppler sonography of TIPSflow, and upper gastrointestinal endoscopy wereperformed at days 1, 7, and 30 and at three-month intervals after TIPS. Mean follow-up was 549(1-987) days. Bleeding was controlled by emergency TIPSin 10/11 patients. Probability of survival was notdifferent after emergency and elective TIPS (0.73 vs 0.84 at one year). Early rebleeding (≤2weeks) occurred more often after emergency TIPS (3/11 vs0/22 patients; P = 0.03), but there was no significantdifference in late rebleeding. Occlusion of TIPS was more frequent after emergency TIPS.Occurrence of TIPS stenoses was identical in both groups(4/11 vs 8/22). De novo or deterioration of preexistinghepatic encephalopathy was similar (18% vs 24%; NS). Itis concluded that TIPS is effective for control of acutevariceal bleeding unresponsive to endoscopic and drugtreatment. Early rebleeding and stent occlusion occurredmore often after emergency TIPS. Late rebleeding, complications, andlong-term survival did not differ from electiveTIPS.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1026686232756
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