Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs. the right branch of the portal vein in advanced cirrhosis: a randomized trial.
OBJECTIVE
The transjugular intrahepatic portosystemic shunt (TIPS) is technically divided into TIPS through the left branch of the portal vein (TIPS-LBPV) and TIPS through the right branch of the portal vein (TIPS-RBPV). In order to compare their advantages and disadvantages, this randomized, controlled trial was designed to investigate their outcomes in advanced cirrhotic patients.


METHODS
Seventy-two patients were randomly placed into TIPS-LBPV (36 patients) and TIPS-RBPV (36 patients, with four failures) groups, and they were prospectively followed for 2 years after TIPS implantation.


RESULTS
Patients who underwent the two different kinds of TIPS were balanced during recruitment for this study. The incidences of overall encephalopathy and de novo encephalopathy in the TIPS-LBPV group were significantly lower than that of the TIPS-RBPV group during follow-up (P=0.036 and 0.012 respectively). The incidences of rebleeding or re-intervention and improvement of ascites were similar between groups (P>0.05). Patients undergoing TIPS-RBPV required more rehospitalization and incurred more costs than those who underwent TIPS-LBPV (P=0.030 and 0.039 respectively). There was no significant difference between the two groups in survival based on a survival curve constructed according to the Kaplan-Meier method (P>0.05).


CONCLUSIONS
Patients undergoing TIPS-LBPV had a lower incidence of encephalopathy, less rehospitalization and lower costs after TIPS implantation compared with patients undergoing TIPS-RBPV.
Chen
Lei
L
Department of Gastroenterology, Southwest Hospital, Third Military Medical University, Chongqing, China.
Xiao
Tianli
T
Chen
Wensheng
W
Long
Qingling
Q
Li
Rongjun
R
Fang
Dianchun
D
Wang
Rongquan
R
D000328:Adult; D001201:Ascites / Q000209:etiology / Q000601:surgery; D017046:Cost Savings; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006501:Hepatic Encephalopathy / Q000209:etiology; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome