Dominique Thabut1, Arnaud Pauwels2, Nicolas Carbonell3, Andre Jean Remy4, Pierre Nahon5, Xavier Causse6, Jean-Paul Cervoni7, Jean-François Cadranel8, Isabelle Archambeaud9, Slim Bramli10, Florent Ehrhard11, Philippe Ah-Soune12, Florian Rostain13, Alexandre Pariente14, Julien Vergniol15, Jean-Pierre Dupuychaffray16, Anne-Laure Pelletier17, Florence Skinazi18, Anne Guillygomarc'h19, René-Louis Vitte20, Jean Henrion21, Stéphanie Combet22, Marika Rudler22, Christophe Bureau23. 1. Sorbonne Universités, UPMC Univ Paris 06, Paris, France; AP-HP, UF de Soins Intensifs d'Hépato-Gastroentérologie, Service d'Hépato-Gastroentérologie, Groupe hospitalier Pitié Salpêtrière, Paris, France. Electronic address: dominique.thabut@psl.aphp.fr. 2. Service d'Hépato-Gastroentérologie, Centre Hospitalier, Gonesse Cedex, France. 3. AP-HP, Service d'Hépato-Gastroentérologie, Hôpital Saint-Antoine, Paris, France. 4. Service d'Hépato-Gastroentérologie, Centre hospitalier de Perpignan, France. 5. AP-HP, Service d'Hépatologie, Hôpital Jean Verdier, Bondy, France. 6. Service d'Hépato-Gastroentérologie, CHR Orléans, Orléans, France. 7. Service d'Hépatologie, CHU de Besançon, Besançon, France. 8. Centre Hospitalier Laennec, GHPSO, Service d'hHépato-Gastroentérologie et de Nutrition, Creil cedex, France. 9. Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France. 10. Service d'Hépato-Gastroentérologie, CHR Avignon, Avignon, France. 11. Service d'Hépato-Gastroentérologie, CHU de Reims, Reims cedex, France. 12. Service d'Hépato-Gastroentérologie, Hôpital Saint-Musse, Toulon, France. 13. Service d'Hépato-Gastroentérologie, CHU de Dijon, Dijon cedex, France. 14. Service d'Hépato-Gastroentérologie, CH de Pau, Pau cedex, France. 15. Service Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France. 16. Service Hépato-gastroentérologie, CH d'Angoulème, Angoulème cedex, France. 17. AP-HP, Service d'Hépato-gastroentérologie, CHU Bichat, Paris, France. 18. Service d'Hépato-Gastroentérologie, Hôpital St Denis, St Denis cedex, France. 19. CHU Pontchaillou, Service d'Hépatologie, Rennes, France. 20. Service de Gastro-Entérologie, Centre Hospitalier Intercommunal de Poissy, Poissy, France. 21. Service d'Hépato-Gastroentérologie. Hôpital de Jolimont, Haine-Saint-Paul, Belgium. 22. Sorbonne Universités, UPMC Univ Paris 06, Paris, France; AP-HP, UF de Soins Intensifs d'Hépato-Gastroentérologie, Service d'Hépato-Gastroentérologie, Groupe hospitalier Pitié Salpêtrière, Paris, France. 23. Service d'Hépato-gastroentérologie, Hôpital Purpan Centre Hospitalier Universitaire Toulouse, Toulouse Cedex, France; Université Paul Sabatier Toulouse III, Toulouse Cedex, France.
Abstract
BACKGROUND: The Baveno VI consensus meeting concluded that an early TIPS must be considered in high-risk cirrhotic patients presenting with variceal bleeding (VB) (Child B + active bleeding at endoscopy or Child C10-13 patients). Whether this therapeutic approach is feasible in a real-life setting remains unclear. AIMS: To determine (1) the proportion of patients eligible for early-TIPS among cirrhotic patients with VB, (2) the proportion of these patients who underwent early-TIPS placement and the main reasons for discarding TIPS, and (3) the outcomes of patients who experienced early-TIPS placement in a large, national, prospective, multicentre audit including academic and non-academic centres. MATERIALS AND METHODS: All French centres recruiting gastrointestinal bleeding were invited to participate. All consecutive patients with cirrhosis and PHT-related bleeding were included. RESULTS: 964 patients were included (58 centres: 26 academic, 32 non-academic; patient characteristics: male sex, 77%; age, 59.6 ± 12.1 years; aetiologies of cirrhosis (alcoholic,viral/other, 67%/15%/18%); source of bleeding (EV/GV/other, 80/11/9%); active bleeding at endoscopy 34%; Child A 21%/B 44%/C 35%. Overall, 35% of the patients were eligible for early-TIPS, but only 6.8%, displaying less severe cirrhosis underwent early-TIPS placement. The main reason for discarding TIPS was a lack of availability. The actuarial probability of survival at one year was significantly increased in early-TIPS patients (85.7±0.07% vs 58.9±0.03%, p=0.04). The severity of liver disease was the only parameter independently associated with improved one-year survival. CONCLUSION: In this real-life study, one-third of the cirrhotic patients admitted for VB fulfilled the criteria for early-TIPS placement, whereas only 7% had access to TIPS. TIPS was restricted to patients displaying less severe cirrhosis. The severity of liver disease was the only parameter that influenced survival.
BACKGROUND: The Baveno VI consensus meeting concluded that an early TIPS must be considered in high-risk cirrhoticpatients presenting with variceal bleeding (VB) (Child B + active bleeding at endoscopy or Child C10-13 patients). Whether this therapeutic approach is feasible in a real-life setting remains unclear. AIMS: To determine (1) the proportion of patients eligible for early-TIPS among cirrhoticpatients with VB, (2) the proportion of these patients who underwent early-TIPS placement and the main reasons for discarding TIPS, and (3) the outcomes of patients who experienced early-TIPS placement in a large, national, prospective, multicentre audit including academic and non-academic centres. MATERIALS AND METHODS: All French centres recruiting gastrointestinal bleeding were invited to participate. All consecutive patients with cirrhosis and PHT-related bleeding were included. RESULTS: 964 patients were included (58 centres: 26 academic, 32 non-academic; patient characteristics: male sex, 77%; age, 59.6 ± 12.1 years; aetiologies of cirrhosis (alcoholic,viral/other, 67%/15%/18%); source of bleeding (EV/GV/other, 80/11/9%); active bleeding at endoscopy 34%; Child A 21%/B 44%/C 35%. Overall, 35% of the patients were eligible for early-TIPS, but only 6.8%, displaying less severe cirrhosis underwent early-TIPS placement. The main reason for discarding TIPS was a lack of availability. The actuarial probability of survival at one year was significantly increased in early-TIPS patients (85.7±0.07% vs 58.9±0.03%, p=0.04). The severity of liver disease was the only parameter independently associated with improved one-year survival. CONCLUSION: In this real-life study, one-third of the cirrhoticpatients admitted for VB fulfilled the criteria for early-TIPS placement, whereas only 7% had access to TIPS. TIPS was restricted to patients displaying less severe cirrhosis. The severity of liver disease was the only parameter that influenced survival.
Authors: Victor Dong; Maxime Gosselin; Nishita Jagarlamudi; Beverley Kok; Mark G Swain; Jasmohan S Bajaj; Juan G Abraldes; Vladimir Marquez; R Todd Stravitz; Aldo J Montano-Loza; Manuela Merli; Phil Wong; Amanda Brisebois; Puneeta Tandon; Julia Wendon; Scott L Nyberg; François M Carrier; Michael R Lucey; Florence Wong; Jordan J Feld; Constantine J Karvellas; Christopher F Rose; Julien Bissonnette Journal: Can Liver J Date: 2019-12-10
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: Justin Richard Boike; Nikhilesh Ray Mazumder; Kanti Pallav Kolli; Jin Ge; Margarita German; Nathaniel Jest; Giuseppe Morelli; Erin Spengler; Adnan Said; Jennifer C Lai; Archita P Desai; Thomas Couri; Sonali Paul; Catherine Frenette; Elizabeth C Verna; Usman Rahim; Aparna Goel; Dyanna Gregory; Bartley Thornburg; Lisa B VanWagner Journal: Am J Gastroenterol Date: 2021-10-01 Impact factor: 12.045