Transjugular intrahepatic portosystemic stent shunt: 11 years' experience at a regional referral centre.
OBJECTIVE
Transjugular intrahepatic portosystemic stent shunt (TIPSS) is now widely used in the treatment of uncontrolled and recurrent variceal haemorrhage. This study reports the outcome and long-term follow-up of 125 patients who were referred to a single centre for TIPSS.


METHODS
One hundred and twenty-five patients were referred to undergo TIPSS. All but 10 had variceal haemorrhage. The 10 patients referred with refractory ascites were excluded from the analysis. Our follow-up protocol was to assess shunt patency only if bleeding recurred or there was a clinical indication. The mean age was 51.5 years (range 18-87 years) and 64 patients (56%) were male. The commonest aetiology for chronic liver disease was alcohol (80%). At referral, 19 patients (16%) were Child-Pugh class A, 26 patients (23%) were Child-Pugh class B and 70 patients (61%) were Child-Pugh class C. The mean follow-up period was 20.4 months (range 0-95 months).


RESULTS
TIPSS was successfully placed in 108 of 115 patients (94%). The thirty-day mortality was 30%. One-year and 2-year overall cumulative survival was 52% (survival ratio, 0.525; 95% confidence interval, 0.432-0.619) and 43% (survival ratio, 0.436; 95% confidence interval, 0.340-0.532), respectively.


CONCLUSIONS
TIPSS is effective in the treatment of uncontrolled or recurrent variceal bleeding. In comparison with previously published studies, our study suggests no value in regular or routine shunt surveillance to reduce rebleeding episodes or mortality, but this needs to be further assessed in prospective randomized studies.
Saravanan
Ramasamy
R
Department of Gastroenterology, Royal Liverpool & Broadgreen University Hospitals, UK.
Nayar
Manu
M
Gilmore
Ian T
IT
Smart
Howard
H
McWilliams
Richard G
RG
Rowlands
Peter C
PC
Evans
Jonathan
J
Murphy
Mike
M
Gould
Derek
D
Taylor
Steve
S
Sutton
Robert
R
Lombard
Martin G
MG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004812:Epidemiologic Methods; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012008:Recurrence; D012017:Referral and Consultation; D012720:Severity of Illness Index; D016896:Treatment Outcome