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TIPSS for variceal bleeding in patients with idiopathic non‐cirrhotic portal hypertension: comparison with patients who have cirrhosis
Author(s) -
Lv Yong,
Li Kai,
He Chuangye,
Luo Bohan,
Zhang Bojing,
Liu Haibo,
Wang Zhengyu,
Guo Wengang,
Wang Qiuhe,
Chen Hui,
Bai Wei,
Yuan Xulong,
Yu Tianlei,
Li Xiaomei,
Yuan Jie,
Han Na,
Zhu Ying,
Niu Jing,
Xie Huahong,
Wang Jianhong,
Chen Ling,
Yin Zhanxin,
Fan Daiming,
Li Zengshan,
Han Guohong
Publication year - 2019
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.15186
Subject(s) - medicine , portal hypertension , cirrhosis , gastroenterology , transjugular intrahepatic portosystemic shunt , hepatic encephalopathy , liver disease , portosystemic shunt , varices , surgery
Summary Background In patients with idiopathic non‐cirrhotic portal hypertension (INCPH), the usual recommended strategy for management of variceal bleeding is the same as that in cirrhosis. However, this policy has been challenged by the different natural history between INCPH and cirrhosis. Aim To compare outcomes after transjugular intrahepatic portosystemic shunt (TIPSS) between INCPH and cirrhotic patients admitted for variceal bleeding. Methods Between March 2001 and September 2015, 76 consecutive patients with biopsy‐proven INCPH undergoing TIPSS for variceal bleeding in a tertiary‐care centre were included. 76 patients with cirrhotic portal hypertension receiving TIPSS for variceal bleeding, and matched for age, sex, Child‐Pugh class, stent type and index year of TIPSS creation served as controls. Results Patients with INCPH, compared to those with cirrhosis, had significantly lower mortality (11% vs 36% at 5 years, adjusted HR, 0.37; 95% CI 0.15‐0.87, P = 0.022), overt hepatic encephalopathy (16% vs 33% at 5 years, adjusted HR, 0.35; 95% CI 0.16‐0.75, P = 0.007) and hepatic impairment, despite similar rates of further bleeding (33% vs 32% at 5 years, adjusted HR, 0.72; 95% CI 0.36‐1.44, P = 0.358), and shunt dysfunction (35% vs 36% at 5 years, adjusted HR, 0.84; 95% CI 0.41‐1.72, P = 0.627). These findings were consistent across different relevant subgroups. Conclusions Patients with INCPH treated with TIPSS for variceal bleeding had similar progression of portal hypertension (further bleeding and shunt dysfunction) but fewer complications of liver disease (overt hepatic encephalopathy and hepatic insufficiency) and lower mortality rate compared with cirrhotic patients with comparable liver function.