Theresa Bucsics1, Maria Schoder2, Nicolas Goeschl1, Philipp Schwabl1, Mattias Mandorfer1, Magdalena Diermayr1, Maria Feldner1, Florian Riedl1, David Bauer1, Bernhard Angermayr3, Manfred Cejna4, Arnulf Ferlitsch1, Wolfgang Sieghart1, Michael Trauner3, Markus Peck-Radosavljevic1, Josef Karner5, Franz Karnel6, Thomas Reiberger7. 1. Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria. 2. Dept. of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. 3. Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria. 4. Dept. of Radiology, Landeskrankenhaus Feldkirch, Austria. 5. Dept. of Surgery, Kaiser-Franz-Josef Hospital, Vienna, Austria. 6. Dept. of Radiology, Kaiser-Franz-Josef Hospital, Vienna, Austria. 7. Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria. Electronic address: thomas.reiberger@meduniwien.ac.at.
Abstract
BACKGROUND: Early implantation (<72h) of a transjugular intrahepatic portosystemic shunt (TIPS) after acute variceal bleeding (AVB) improves survival in highly selected patients. METHODS: We retrospectively assessed bleeding control and survival of unselected cirrhotic patients undergoing early TIPS implantation within 72h. We compared the outcomes to patients meeting early TIPS criteria but receiving late TIPS within 3-28days after AVB and endoscopic/medical treatment. RESULTS: Forty-nine patients were included. Mean MELD was 14.4 (±4.4). Thirteen patients (26.5%) presented characteristics that were exclusion criteria in previous early TIPS trials (age>75, CPS>13, HCC>Milan, previous beta-blocker/band-ligation, renal insufficiency). Bare metal and PTFE-covered stents were used in n=32 (65.3%) and n=17 (34.7%) patients, respectively, and showed similar early re-bleeding rates (9.9% vs. 7.1%; p=0.6905) and bleeding-related mortality (25.0% vs. 23.5%; p=0.9906). However, overall re-bleeding rate was lower with PTFE-TIPS (7.7% vs. 64.2%; p=0.0044) over a median follow-up of 18.5 months with a tendency towards improved survival (median 70.5 vs. 13.8 months; p=0.204). Additional 68 patients meeting stringent criteria but receiving late TIPS also showed a favorable bleeding-related mortality (8.8%), which was not achieved in similar n=34 patients by a medical/endoscopic strategy with bleeding-related mortality of 35.7%. CONCLUSIONS: An early TIPS strategy using covered stents and implementation of 'stringent criteria' results in a favorable outcome in patients with acute variceal bleeding.
BACKGROUND: Early implantation (<72h) of a transjugular intrahepatic portosystemic shunt (TIPS) after acute variceal bleeding (AVB) improves survival in highly selected patients. METHODS: We retrospectively assessed bleeding control and survival of unselected cirrhotic patients undergoing early TIPS implantation within 72h. We compared the outcomes to patients meeting early TIPS criteria but receiving late TIPS within 3-28days after AVB and endoscopic/medical treatment. RESULTS: Forty-nine patients were included. Mean MELD was 14.4 (±4.4). Thirteen patients (26.5%) presented characteristics that were exclusion criteria in previous early TIPS trials (age>75, CPS>13, HCC>Milan, previous beta-blocker/band-ligation, renal insufficiency). Bare metal and PTFE-covered stents were used in n=32 (65.3%) and n=17 (34.7%) patients, respectively, and showed similar early re-bleeding rates (9.9% vs. 7.1%; p=0.6905) and bleeding-related mortality (25.0% vs. 23.5%; p=0.9906). However, overall re-bleeding rate was lower with PTFE-TIPS (7.7% vs. 64.2%; p=0.0044) over a median follow-up of 18.5 months with a tendency towards improved survival (median 70.5 vs. 13.8 months; p=0.204). Additional 68 patients meeting stringent criteria but receiving late TIPS also showed a favorable bleeding-related mortality (8.8%), which was not achieved in similar n=34 patients by a medical/endoscopic strategy with bleeding-related mortality of 35.7%. CONCLUSIONS: An early TIPS strategy using covered stents and implementation of 'stringent criteria' results in a favorable outcome in patients with acute variceal bleeding.
Authors: Theresa Bucsics; Katharina Lampichler; Constantin Vierziger; Maria Schoder; Florian Wolf; David Bauer; Benedikt Simbrunner; Lukas Hartl; Mathias Jachs; Bernhard Scheiner; Michael Trauner; Thomas Gruenberger; Franz Karnel; Mattias Mandorfer; Thomas Reiberger Journal: Dig Dis Sci Date: 2022-03-17 Impact factor: 3.199
Authors: Nikolaus Pfisterer; Caroline Schmidbauer; Florian Riedl; Andreas Maieron; Vanessa Stadlbauer; Barbara Hennlich; Remy Schwarzer; Andreas Puespoek; Theresa Bucsics; Maria Effenberger; Simona Bota; Michael Gschwantler; Markus Peck-Radosavljevic; Mattias Mandorfer; Christian Madl; Michael Trauner; Thomas Reiberger Journal: Wien Klin Wochenschr Date: 2020-12-03 Impact factor: 1.704
Authors: Benedikt Simbrunner; Rodrig Marculescu; Bernhard Scheiner; Philipp Schwabl; Theresa Bucsics; Alexander Stadlmann; David J M Bauer; Rafael Paternostro; Ernst Eigenbauer; Matthias Pinter; Albert Friedrich Stättermayer; Michael Trauner; Mattias Mandorfer; Thomas Reiberger Journal: Liver Int Date: 2020-05-18 Impact factor: 5.828
Authors: Justin R Boike; Bartley G Thornburg; Sumeet K Asrani; Michael B Fallon; Brett E Fortune; Manhal J Izzy; Elizabeth C Verna; Juan G Abraldes; Andrew S Allegretti; Jasmohan S Bajaj; Scott W Biggins; Michael D Darcy; Maryjane A Farr; Khashayar Farsad; Guadalupe Garcia-Tsao; Shelley A Hall; Caroline C Jadlowiec; Michael J Krowka; Jeanne Laberge; Edward W Lee; David C Mulligan; Mitra K Nadim; Patrick G Northup; Riad Salem; Joseph J Shatzel; Cathryn J Shaw; Douglas A Simonetto; Jonathan Susman; K Pallav Kolli; Lisa B VanWagner Journal: Clin Gastroenterol Hepatol Date: 2021-07-15 Impact factor: 13.576