Saher S Sabri1, Nadine Abi-Jaoudeh2, Warren Swee3, Wael E Saad4, Ulku C Turba4, Stephen H Caldwell5, John F Angle4, Alan H Matsumoto4. 1. Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908. Electronic address: Ss2bp@virginia.edu. 2. Department of Diagnostic Radiology, National Institutes of Health, Bethesda, Maryland. 3. South Florida Vascular Associates, Coconut Creek, Florida. 4. Division of Angiography, Interventional Radiology, and Special Procedures, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908. 5. Department of Radiology and Medical Imaging, and Division of Gastroenterology, Department of Medicine, University of Virginia Health System, 1215 Lee Street/Box 800170, Charlottesville, VA 22908.
Abstract
PURPOSE: To assess the short-term rebleeding rate associated with the use of a transjugular intrahepatic portosystemic shunt (TIPS) compared with balloon-occluded retrograde transvenous obliteration (BRTO) for management of gastric varices (GV). MATERIALS AND METHODS: A single-center retrospective comparison of 50 patients with bleeding from GV treated with a TIPS or BRTO was performed. Of 50 patients, 27 (17 men and 10 women; median age, 55 y; range, 31-79 y) received a TIPS with covered stents, and 23 (12 men and 11 women; median age, 52 y; range, 23-83 y) underwent a BRTO procedure with a foam sclerosant. All study subjects had clinical and endoscopic evidence of isolated bleeding GV and were hemodynamically stable at the time of the procedure. Clinical and endoscopic follow-up was performed. Kaplan-Meier analysis was used to evaluate rebleeding rates from the GV. RESULTS: The technical success rate was 100% in the TIPS group and 91% in the BRTO group (P = .21). Major complications occurred in 4% of the patients receiving TIPS and 9% of patients the undergoing BRTO (P = .344). Encephalopathy was reported in 4 of 27 (15%) patients in the TIPS group and in none of the patients in the BRTO group (0%; P = .12). At 12 months, the incidence of rebleeding from a GV source was 11% in the TIPS group and 0% in the BRTO group (P = .25). CONCLUSIONS: BRTO appears to be equivalent to TIPS in the short-term for management of bleeding GV. Further comparative studies are warranted to determine optimal management strategies in individual patients.
PURPOSE: To assess the short-term rebleeding rate associated with the use of a transjugular intrahepatic portosystemic shunt (TIPS) compared with balloon-occluded retrograde transvenous obliteration (BRTO) for management of gastric varices (GV). MATERIALS AND METHODS: A single-center retrospective comparison of 50 patients with bleeding from GV treated with a TIPS or BRTO was performed. Of 50 patients, 27 (17 men and 10 women; median age, 55 y; range, 31-79 y) received a TIPS with covered stents, and 23 (12 men and 11 women; median age, 52 y; range, 23-83 y) underwent a BRTO procedure with a foam sclerosant. All study subjects had clinical and endoscopic evidence of isolated bleeding GV and were hemodynamically stable at the time of the procedure. Clinical and endoscopic follow-up was performed. Kaplan-Meier analysis was used to evaluate rebleeding rates from the GV. RESULTS: The technical success rate was 100% in the TIPS group and 91% in the BRTO group (P = .21). Major complications occurred in 4% of the patients receiving TIPS and 9% of patients the undergoing BRTO (P = .344). Encephalopathy was reported in 4 of 27 (15%) patients in the TIPS group and in none of the patients in the BRTO group (0%; P = .12). At 12 months, the incidence of rebleeding from a GV source was 11% in the TIPS group and 0% in the BRTO group (P = .25). CONCLUSIONS: BRTO appears to be equivalent to TIPS in the short-term for management of bleeding GV. Further comparative studies are warranted to determine optimal management strategies in individual patients.
Authors: Dhiraj Tripathi; Adrian J Stanley; Peter C Hayes; David Patch; Charles Millson; Homoyon Mehrzad; Andrew Austin; James W Ferguson; Simon P Olliff; Mark Hudson; John M Christie Journal: Gut Date: 2015-04-17 Impact factor: 23.059
Authors: Thomas Reiberger; Andreas Püspök; Maria Schoder; Franziska Baumann-Durchschein; Theresa Bucsics; Christian Datz; Werner Dolak; Arnulf Ferlitsch; Armin Finkenstedt; Ivo Graziadei; Stephanie Hametner; Franz Karnel; Elisabeth Krones; Andreas Maieron; Mattias Mandorfer; Markus Peck-Radosavljevic; Florian Rainer; Philipp Schwabl; Vanessa Stadlbauer; Rudolf Stauber; Herbert Tilg; Michael Trauner; Heinz Zoller; Rainer Schöfl; Peter Fickert Journal: Wien Klin Wochenschr Date: 2017-10-23 Impact factor: 1.704