Transjugular intrahepatic portosystemic stent shunt as a rescue treatment after sclerotherapy failure in variceal bleeding.
BACKGROUND
Variceal bleeding carries high early mortality, especially after failure of conventional treatments such as endoscopic injection therapy. The present study analyses the efficacy of transjugular intrahepatic portosystemic stent shunt (TIPS) in cirrhotic patients after failure of sclerotherapy for variceal bleeding.


METHODS
Twenty-four consecutive patients underwent TIPS in this indication.


RESULTS
The procedure was successful in all patients, with reduction of size or disappearance of varices in 96% of them. Four patients (17%) developed encephalopathy and six (25%) rebled during the follow-up period (median 5 months; range 1-19). Thirty-day mortality was only 17% and 29% during the follow-up period. Deaths were mainly due to liver failure, especially after procedures performed in emergency. Significant decrease in liver function was observed in the days following the procedure. To maintain long-term patency of the shunt, revision was required in nine patients (38%).


CONCLUSIONS
TIPS seems to be a promising salvage therapeutic procedure after failed sclerotherapy, but this needs to be addressed in controlled trials.
Le Moine
O
O
Dept. of Gastroenterology and Radiology, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Devière
J
J
Ghysels
M
M
François
E
E
Rypens
F
F
Van Gansbeke
D
D
Bourgeois
N
N
Adler
M
M
D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D015911:Sclerotherapy; D015607:Stents; D015996:Survival Rate; D017211:Treatment Failure