Ten years' follow-up of 472 patients following transjugular intrahepatic portosystemic stent-shunt insertion at a single centre.
BACKGROUND
Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is increasingly used for the management of portal hypertension. We report on 10 years' experience at a single centre.


METHODS
Data held in a dedicated database was retrieved on 497 patients referred for TIPSS. The efficacy of TIPSS and its complications were assessed.


RESULTS
Most patients were male (59.4%) with alcoholic liver disease (63.6%), and bleeding varices (86.8%). Technical success was achieved in 474 (95.4%) patients. A total of 13.4% of patients bled at portal pressure gradients < or = 12 mmHg, principally from gastric and ectopic varices. Procedure-related mortality was 1.2%. The mean follow-up period of surviving patients was 33.3 +/- 1.9 months. Primary shunt patency rates were 45.4% and 26.0% at 1 and 2 years, respectively, while the overall secondary assisted patency rate was 72.2%. Variceal rebleeding rate was 13.7%, with all episodes occurring within 2 years of TIPSS insertion, and almost all due to shunt dysfunction. The overall mortality rate was 60.4%, mainly resulting from end-stage liver failure (42.5%). Patients who bled from gastric varices had lower mortality than those from oesophageal varices (53.9% versus 61.5%, P < 0.01). The overall rate of hepatic encephalopathy was 29.9% (de novo encephalopathy was 11.5%), with pre-TIPSS encephalopathy being an independent predicting variable. Refractory ascites responded to TIPSS in 72% of cases, although the incidence of encephalopathy was high in this group (36.0%).


CONCLUSIONS
TIPSS is effective in the management of variceal bleeding, and has a low complication rate. With surveillance, good patency can be achieved. Careful selection of patients is needed to reduce the encephalopathy rate.
Tripathi
Dhiraj
D
Liver Unit, The Royal Infirmary, Edinburgh, UK. d.tripathi@ed.ac.uk
Helmy
Ahmed
A
Macbeth
Kim
K
Balata
Sherzad
S
Lui
Hock F
HF
Stanley
Adrian J
AJ
Redhead
Doris N
DN
Hayes
Peter C
PC
D001201:Ascites / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality; D012008:Recurrence; D012044:Regression Analysis; D016896:Treatment Outcome