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Transjugular intrahepatic portosystemic shunt in patients treated with a balloon tamponade for variceal hemorrhage without response to high doses of vasoactive drugs: A real‐world multicenter retrospective study
Author(s) -
Ni Jing Bin,
Xiang Xiao Xing,
Wu Wei,
Chen Shi Yao,
Zhang Feng,
Zhang Ming,
Peng Chun Yan,
Xiao Jiang Qiang,
Zhuge Yu Zheng,
Zhang Chun Qing
Publication year - 2021
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12978
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , balloon tamponade , portal hypertension , hemostasis , tamponade , cirrhosis , balloon , surgery , hepatic encephalopathy , gastroenterology
Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) and non‐TIPS therapy (endoscopy and/or nonselective beta‐blockers [NSBB]) in patients with cirrhosis and active variceal hemorrhage who did not respond to high‐dose vasoactive drugs and required balloon tamponade for hemostasis. Methods Medical records of cirrhotic patients who did not respond to high‐dose vasoactive drugs and required balloon tamponade for hemostasis at five university hospitals in China between January 2011 and December 2018 were reviewed. Treatment outcomes were compared between the TIPS and the non‐TIPS groups. Results Treatment failure of variceal hemorrhage within 5 days was reported in six patients of the non‐TIPS group (N = 70) and none of the TIPS group (N = 66) ( P = .028). The TIPS group had a higher 1‐year variceal rebleeding‐free rate compared with the non‐TIPS group (95.5% vs 60.0%, P < .001). One patient treated with TIPS and nine with non‐TIPS therapy experienced rebleeding within 5 days and 6 weeks after the intervention ( P = .009). The cumulative 1‐year survival rate was higher in the TIPS group than in the non‐TIPS group (93.9% vs 78.6%, P = .01). The TIPS group had a higher incidence of hepatic encephalopathy within one year compared with the non‐TIPS group (18.2% vs 4.3%, P = .026). Conclusion For patients with cirrhosis and active variceal bleeding who do not respond to high‐dose vasoactive agents and require a balloon tamponade for hemostasis, TIPS may be an appropriate treatment choice.