TIPS versus transcatheter sclerotherapy for gastric varices.
OBJECTIVE
The purpose of our study was to compare the efficacy and long-term results of transjugular intrahepatic portosystemic shunt (TIPS) with those of transcatheter sclerotherapy for the treatment of gastric varices.


METHODS
A total of 139 cirrhotic patients with gastric varices underwent endovascular treatment. Of the 139 patients, 104 without hepatocellular carcinoma were enrolled; 27 patients were treated with TIPS, and 77 patients with transcatheter sclerotherapy. Bleeding of gastric varices and survival rates were compared between the TIPS and transcatheter sclerotherapy groups. Multivariate analysis was used to identify the prognostic factors for gastric variceal bleeding and survival. Changes in liver function were evaluated in each group.


RESULTS
The cumulative gastric variceal bleeding rate at 1 year was 20% in the TIPS group and 2% in the transcatheter sclerotherapy group (p < 0.01). The prognostic factor associated with gastric variceal bleeding was the treatment method. The cumulative survival rates at 1, 3, and 5 years were, respectively, 81%, 64%, and 40% in the TIPS group and 96%, 83%, and 76% in the transcatheter sclerotherapy group (p < 0.01). The prognostic factors for survival were the treatment method and the Child-Pugh classification of liver disease. For patients categorized in Child-Pugh class A, the survival rate was higher in the transcatheter sclerotherapy group than in the TIPS group (p < 0.01). For patients in Child-Pugh classes B and C, no significant difference was seen between the two groups. Liver function tended to improve in the transcatheter sclerotherapy group.


CONCLUSIONS
Transcatheter sclerotherapy may provide better control of gastric variceal bleeding than TIPS. Transcatheter sclerotherapy may contribute to a higher survival rate than TIPS in patients with Child-Pugh class A disease.
Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. ninoi@msic.med.osaka-cu.ac.jp
Teruhisa
T
Ninoi
Kenji
K
Nakamura
Toshio
T
Kaminou
Norifumi
N
Nishida
Yukimasa
Y
Sakai
Toshiaki
T
Kitayama
Masao
M
Hamuro
Ryusaku
R
Yamada
Tetsuo
T
Arakawa
Yuichi
Y
Inoue
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D015999:Multivariate Analysis; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D012307:Risk Factors; D015911:Sclerotherapy; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome