[Initial clinical experiences with TIPS (transjugular intrahepatic portasystemic stent-shunt)].
15 patients with predominantly alcoholtoxic liver cirrhosis (mean age 50 years; 8 men and 7 women) were treated by the technically successful implantation of a transjugular portosystemic stent-shunt (TIPS) within a period of 1 year. The indications for TIPS implantation were the following: gastroesophageal bleedings in 12 cases (10 patients with recurrent variceal bleeding including 2 emergency cases with severe bleeding resistant to conventional therapy and 2 patients with exclusively gastral bleeding due to severe hypertensive gastropathy) and ascites resistant to conventional therapy in 3 cases. Portovenous pressure could be effectively reduced by mean of 37%. Within a mean observation period of 8 months 13 patients including the emergency cases remained without recurrent bleeding. Duplexsonography showed patent stents. 1 patient suffered from an early recurrent bleeding due to occlusion of the stent-shunt. The estimation of liver function according to the Child-Pugh-classification showed only minor changes. Before TIPS 9 patients were in class A, 4 in B, 2 in C; after TIPS 8 patients in A, 5 in B and 2 in C. Ascites resolved completely. Following TIPS all patients appeared to abstain from alcohol. After TIPS 5 from 14 surviving patients (36%) developed clinically manifest encephalopathy within the first 4-8 weeks (2 patients with previous episodes of encephalopathy, 2 other patients after withdrawal of lactulose). By enhanced conservative treatment (lactulose, paromomycine and protein restriction) encephalopathy could be overcome. 8 from 11 surviving patients investigated displayed characteristic MRI changes with an increased signal intensity in the basal ganglia (T1 weighted images). According to our preliminary results TIPS represents a new successful interventional regimen for the treatment of portal hypertension in selected cases.
Nolte
W
W
Medizinische Klinik, Georg-August-Universität, Göttingen.
Wiltfang
J G
JG
Kunert
H J
HJ
Thiel
A
A
Geese
K
K
Peters
K
K
Figulla
H R
HR
Hartmann
H
H
Ramadori
G
G
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002408:Catheters, Indwelling; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D006801:Humans; D007601:Jugular Veins; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000295:instrumentation*; D012008:Recurrence; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
Erste klinische Erfahrungen mit TIPS (transjugulärer intrahepatischer portosystemischer Stent-Shunt).