[Portasystemic anastomosis by transjugular approach: treatment of active and refractory hemorrhage caused by rupture of esophageal varices. Results in 11 patients].
OBJECTIVE
The aim of this study was to assess the feasibility and efficacy of transjugular intrahepatic portosystemic shunts for refractory variceal bleeding, uncontrolled by sclerotherapy or endoscopic ligation.


METHODS
11 patients (mean age: 52 years) with cirrhosis admitted for refractory haemorrhage from ruptured oesophageal varices were included in this study. Eight patients were Child-Pugh class C. All patients were actively bleeding.


RESULTS
All the procedures were successful. Variceal haemorrhage stopped within 24 h. There was no mortality during the procedure. Early complications such as rebleeding (18%) and thrombosis (18%) occurred. Thirty days mortality was 27%. Follow-up in the 8 surviving patients was 19.5 +/- 8 months. Three patients developed recurrent bleeding, from non-variceal sources in 2. In 4 surviving patients, occlusion of the shunt was treated with dilatation or insertion of a second stent. The incidence of hepatic encephalopathy was 25%. Five patients subsequently underwent liver transplantation. Among the 3 patients ineligible for transplantation, one died of hepatocellular carcinoma after 10 months. The 2 others were alive after 19 and 25 months, respectively.


CONCLUSIONS
These results suggest that transjugular intrahepatic portosystemic shunt is a safe and effective procedure of portal decompression in patients with refractory variceal bleeding. Prospective trials comparing this percutaneous procedure and surgical treatment are required.
Bizollon
T
T
Service d'Hépato-Gastroentérologie, Lyon.
Genin
G
G
Gaudin
J L
JL
Jellouli
F
F
Tourasse
C
C
Borson
O
O
Valette
P J
PJ
Souquet
J C
JC
Trépo
C
C
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011172:Portography; D011183:Postoperative Complications; D012008:Recurrence; D012422:Rupture, Spontaneous
Anastomose porto-systémique par voie transjugulaire: traitement de l'hémorragie par rupture de varices oesophagiennes active et réfractaire. Résultats chez 11 malades.