Esophageal Varices: TIPS or Ligation. What Is Your Final Answer?

ARTICLE SUMMARY A randomized study was conducted comparing two-year survival and rebleeding rates in patients with liver cirrhosis (Child-Pugh score 12 or less) receiving either transjugular intrahepatic portosystemic shunt (TIPS) (n=41) or serial endoscopic variceal ligation (EVL) (n=39) after initial control of bleeding. Patients with fundal varices were excluded. There was no difference in the two-year rates of survival between the groups (57% in the TIPS group compared with 56% in the EVL group), whereas the two-year rebleeding rates were 18.5% in the TIPS group and 66% in the EVL group (P<0.001). No patient who received TIPS suffered uncontrolled bleeding, whereas 11 banded patients had uncontrolled bleeding – of whom eight underwent emergency TIPS and the remaining three died. There was no difference in the rates of encephalopathy at two years between the two groups (44% in the TIPS group, 47% in the EVL group). Likewise, the numbers of days spent in hospital were similar between the two groups, both during the index bleed and over two years. The probability of shunt dysfunction in the TIPS group was 73% at two years.