title: Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study.
abstract: OBJECTIVE
  In a recent randomized international clinical trial (RCT) in high-risk cirrhotic patients with acute variceal bleeding, the early use of transjugular intrahepatic portosystemic shunt (TIPS) was associated with marked and significant reductions in both treatment failure and mortality. The aim of this study was to confirm these results in clinical practice in the same centers of the RCT study.
  
  
  METHODS
  We retrospectively reviewed patients admitted for acute variceal bleeding and high risk of treatment failure (Child C <14 or Child B plus active bleeding), treated with early-TIPS (n=45) or drugs+endoscopic therapy (ET) (n=30).
  
  
  RESULTS
  Patients treated with early-TIPS had a much lower incidence of failure to control bleeding or rebleeding than patients receiving drug+ET (3 vs. 15; p <0.001). The 1-year actuarial probability of remaining free of this composite end point was 93% vs. 53% (p <0.001). The same was observed in mortality (1-year actuarial survival was 86% vs. 70% respectively; p=0.056). Actuarial curves of failure to control bleeding+rebleeding and of survival were well within the confidence intervals of those observed in the RCT.
  
  
  CONCLUSIONS
  This study supports the early use of TIPS in patients with cirrhosis and a high-risk variceal bleeding.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain. jcgarcia@clinic.ub.es
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Pagán
authors.forename: Marco
authors.initials: M
authors.lastname: Di Pascoli
authors.forename: Karel
authors.initials: K
authors.lastname: Caca
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.forename: Cristophe
authors.initials: C
authors.lastname: Bureau
authors.forename: Beate
authors.initials: B
authors.lastname: Appenrodt
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
authors.forename: Alexander
authors.initials: A
authors.lastname: Zipprich
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Vinel
authors.forename: Tilman
authors.initials: T
authors.lastname: Sauerbruch
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality*; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality* / Q000601:surgery; D015994:Incidence; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome