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Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study
Author(s) -
Oey Rosalie C.,
Wit Koos,
Moelker Adriaan,
Atalik Tugce,
Delden Otto M.,
Maleux Geert,
Erler Nicole S.,
Takkenberg R. Bart,
Man Robert A.,
Nevens Frederik,
Buuren Henk R.
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14947
Subject(s) - medicine , varices , portal hypertension , retrospective cohort study , surgery , liver disease , hepatic encephalopathy , duodenum , gastroenterology , esophageal varices , confidence interval , cirrhosis
Summary Background Evidence for the efficacy of TIPSS in ectopic variceal bleeding (Ect VB ) is largely based on relatively small series. Aim To define the efficacy of TIPSS in Ect VB . Methods Retrospective analysis of consecutive patients with chronic liver disease who presented with Ect VB and received TIPSS in three tertiary centres in 1992‐2016. Results The study included 53 patients (70% male, median age 61 years, median model for end‐stage liver disease ( MELD ) score 11). The ectopic varices were located around the insertion of stomas (40%), duodenum (23%), rectum (17%) and at other sites (20%). Three‐quarters of the patients had previously received unsuccessful medical, endoscopic or surgical therapy. The median follow‐up was 14.0 months. Following TIPSS , bleeding recurred in 12 patients: 6 of 12 (50%) with duodenal varices, 2 of 9 (22%) with rectal varices and one each with stomal (1/21), intraperitoneal (1/3), hepaticojejunostomy (1/2) and ascending colon varices (1/2). The risk factors for re‐bleeding were MELD score at TIPSS placement ( HR : 1.081 per point; 95% confidence interval ( CI ): 1.012‐1.153; P = 0.034), varices located at site other than an enterostomy ( HR : 9.770; 95% CI : 1.241‐76.917; P = 0.030) and previous local therapy ( HR : 5.710; 95% CI : 1.211‐26.922; P = 0.028). The estimated cumulative re‐bleeding rate was 23% at 1 year, 26% at 3 years and 32% at 5 years. Post‐ TIPSS hepatic encephalopathy manifested or worsened in 16 of 53 patients (30%). Conclusion TIPSS provides long‐term control of bleeding in most cirrhotic patients with Ect VB . TIPSS is particularly effective in stomal Ect VB , the most frequent cause of Ect VB , but might not be as effective in duodenal Ect VB .