[Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices].
OBJECTIVE
Gastric variceal bleeding is a severe complication of liver cirrhosis with a high mortality. The purpose of this study was to determine the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with gastric variceal bleedings and predictive factors for survival.


METHODS
We retrospectively analyzed the medical records of 30 consecutive patients with gastric variceal bleedings from January 1998 to March 2001. The causes of cirrhosis were viral hepatitis in 17, alcohol in 12, and biliary cirrhosis in 1. Eighteen patients were in Child-Pugh class B and 9 in class C at the time of TIPS. The median follow-up period was 403 days (3-1,215 days).


RESULTS
TIPS insertion was successful in all 30 patients. The portal pressure gradient (PPG) was significantly reduced from 23+/-8 mmHg to 11+/-5 mmHg (p<0.05). Hepatic encephalopathy, which developed in 3 patients and was aggravated in 1, was improved with medical therapy. Patients with non-alcoholic etiology experienced deterioration of liver function after TIPS. Those with alcoholic etiology did not. The 6-month and 1-year rebleeding rates were 22% and 41%, respectively. 56% of bleeding episodes were associated with stent dysfunction. The degree of PPG reduction and the development of stent dysfunction were independent predictive factors for rebleeding. The 6-month and 1-year survival rates were 83% and 79%. The causes of death were hepatic failure in 3 (37.5%), recurrent variceal bleeding in 3, and others in 2. Child-Pugh class C was the only prognostic factor for survival.


CONCLUSIONS
TIPS was effective in acute hemostasis and the prevention of rebleeding in patients with gastric variceal bleeding. Especially, it can be safely applied to patients with alcoholic etiology and in Child-Pugh class A or B.
Song
Hee Gon
HG
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Lee
Han Chu
HC
Park
Young Hwan
YH
Jung
Saera
S
Chung
Young-Hwa
YH
Lee
Yung Sang
YS
Yoon
Hyun Ki
HK
Sung
Kyu Bo
KB
Suh
Dong Jin
DJ
D000328:Adult; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012008:Recurrence