title: Efficacy of transjugular intrahepatic portosystemic shunt with adjunctive embolotherapy with cyanoacrylate for esophageal variceal bleeding.
abstract: BACKGROUND
  Transjugular intrahepatic portosystemic shunt (TIPS) with adjunctive embolotherapy has recently been reported to be effective in the prevention of variceal hemorrhage of cirrhotic patients. However, further investigation of its long-term efficacy is still needed.
  
  
  OBJECTIVE
  To examine the rebleeding, survival, and hepatic encephalopathy (HE) after treatment with TIPS alone and TIPS with adjunctive embolotherapy using cyanoacrylate for esophageal variceal bleeding.
  
  
  METHODS
  Patients with refractory to endoscopic therapy for esophageal variceal bleeding were enrolled. TIPS was performed in 101 patients with adjunctive embolotherapy (n = 53) or alone (n = 48) between January 2006 and December 2011. Chart reviews were performed to determine rebleeding, survival rates, and the incidence of HE.
  
  
  RESULTS
  Recurrent hemorrhage occurred in 12 (11.9 %) patients during the mean follow-up periods of 35.8 months. Rebleeding was observed in 9/48 (18.8 %) patients in TIPS alone group and 3/53 (5.7 %) patients in TIPS with adjunctive embolotherapy group (p = 0.042). Death occurred in 30 patients during follow-up (TIPS alone: n = 16, TIPS with adjunctive embolotherapy: n = 14, p = 0.447). Twenty-six episodes of HE occurred in 18 patients in TIPS alone group and 16 episodes occurred in 10 patients in TIPS with embolotherapy group. The probability of HE was significantly higher in TIPS alone group than in TIPS with embolotherapy group (p = 0.019).
  
  
  CONCLUSIONS
  TIPS with adjunctive embolotherapy with cyanoacrylate is relatively safe and effective, with a lower rebleeding and HE incidence in comparison of TIPS alone.
authors.affiliation: Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Road, Jinan, 250021, Shandong, People's Republic of China, dyshiyongjun@163.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Shi
authors.forename: Xiangguo
authors.initials: X
authors.lastname: Tian
authors.forename: Jinhua
authors.initials: J
authors.lastname: Hu
authors.forename: Junyong
authors.initials: J
authors.lastname: Zhang
authors.forename: Chunqing
authors.initials: C
authors.lastname: Zhang
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Yang
authors.forename: Chengyong
authors.initials: C
authors.lastname: Qin
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives
references.citation: Gastroenterology. 1981 May;80(5 pt 1):1031-6
references.pmid: 7009311
references.citation: Gut. 2001 Mar;48(3):390-6
references.pmid: 11171831
references.citation: Radiology. 1999 Aug;212(2):411-21
references.pmid: 10429698
references.citation: Dig Dis Sci. 2008 Aug;53(8):2258-67
references.pmid: 18038208
references.citation: Radiology. 2004 Jun;231(3):820-30
references.pmid: 15118117
references.citation: Hepatology. 2007 Sep;46(3):922-38
references.pmid: 17879356
references.citation: J Clin Gastroenterol. 2011 Aug;45(7):643-50
references.pmid: 21301360
references.citation: Hepatology. 1990 Mar;11(3):348-52
references.pmid: 2312049
references.citation: J Hepatol. 2005 Jul;43(1):167-76
references.pmid: 15925423
references.citation: J Vasc Interv Radiol. 2004 Mar;15(3):239-48
references.pmid: 15028808
references.citation: Radiology. 1994 Apr;191(1):183-7
references.pmid: 8134568
references.citation: Br J Radiol. 2010 Jan;83(985):e22-4
references.pmid: 20139245
references.citation: Lancet. 1976 Jul 10;2(7976):53-5
references.pmid: 59145
references.citation: Radiology. 2005 Jul;236(1):360-7
references.pmid: 15955858
references.citation: AJR Am J Roentgenol. 1989 Apr;152(4):755-60
references.pmid: 2784259
references.citation: Hepatology. 2002 Feb;35(2):385-92
references.pmid: 11826413
references.citation: N Engl J Med. 1974 Sep 26;291(13):646-9
references.pmid: 4546968
references.citation: Radiology. 1983 Mar;146(3):621-5
references.pmid: 6600846
references.citation: J Vasc Interv Radiol. 2004 Nov;15(11):1219-30
references.pmid: 15525740
references.citation: Radiology. 1993 May;187(2):413-20
references.pmid: 8475283
references.citation: Cardiovasc Intervent Radiol. 1997 Jan-Feb;20(1):29-37
references.pmid: 8994721
references.citation: Surgery. 1993 Oct;114(4):719-26; discussion 726-7
references.pmid: 8211686
references.citation: N Engl J Med. 2010 Jun 24;362(25):2370-9
references.pmid: 20573925
references.citation: Eur Radiol. 2004 Oct;14(10):1842-50
references.pmid: 15221261
references.citation: J Clin Gastroenterol. 2009 May-Jun;43(5):463-9
references.pmid: 19142166
references.citation: J Hepatobiliary Pancreat Sci. 2010 Sep;17(5):701-8
references.pmid: 20703849