Transjugular intrahepatic portasystemic shunt vs surgical shunt in good-risk cirrhotic patients: a case-control comparison.
OBJECTIVE
In good-risk patients with variceal bleeding undergoing portal decompression, surgical shunt is more effective, more durable, and less costly than angiographic shunt (transjugular intrahepatic portasystemic shunt [TIPS]).


METHODS
Retrospective case-control study.


METHODS
Academic referral center for liver disease.


METHODS
Patients with Child-Pugh class A or B cirrhosis with at least 1 prior episode of bleeding from portal hypertension (gastroesophageal varices, portal hypertensive gastropathy).


METHODS
Portal decompression by angiographic (TIPS) or surgical (portacaval, distal splenorenal) shunt.


METHODS
Thirty-day and long-term mortality, postintervention diagnostic procedures (endoscopic, ultrasonographic, and angiographic studies), hospital readmissions, variceal rebleeding episodes, blood transfusions, shunt revisions, and hospital and professional charges.


RESULTS
Patients with Child-Pugh class A or B cirrhosis undergoing TIPS (n = 20) or surgical shunt (n = 20) were followed up for 385 and 456 patient-months, respectively. Thirty-day mortality was greater following TIPS compared with surgical shunt (20% vs 0%; P =.20); long-term mortality did not differ. Significantly more rebleeding episodes (P<.001); rehospitalizations (P<.05); diagnostic studies of all types (P<.001); shunt revisions (P<.001); and hospital (P<.005), professional (P<.05), and total (P<. 005) charges occurred following TIPS compared with surgical shunt.


CONCLUSIONS
Operative portal decompression is more effective, more durable, and less costly than TIPS in Child-Pugh class A and B cirrhotic patients with variceal bleeding. Good-risk patients with portal hypertensive bleeding should be referred for surgical shunt.
Helton
W S
WS
Providence Seattle Medical Center, 500 16th Ave, Seattle, WA 98124, USA.
Maves
R
R
Wicks
K
K
Johansen
K
K
D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000191:economics / Q000401:mortality; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome