title: Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices.
abstract: OBJECTIVE
  Stomal varices can cause life-threatening gastrointestinal hemorrhage in patients with portal hypertension. Optimal therapy is not well defined. The purpose of this study was to determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for the treatment of hemorrhagic stomal varices.
  
  
  METHODS
  All patients who underwent TIPS creation for hemorrhagic stomal varices refractory to medical or endoscopic therapy over a 20-year period (1992-2012) were included. Ten patients (mean age, 63 ± 12 years) were identified. Retrospective chart review was used to document demographic characteristics, procedure details, technical and clinical success, complications, recurrent hemorrhage, and need for repeat interventions. Patients underwent follow-up for an average of 2 years (range, 22 days-9.6 years).
  
  
  RESULTS
  All patients had cirrhosis and portal hypertension. Average corrected sinusoidal pressures were 11 ± 2.4 mm Hg (range, 6-15 mm Hg) before TIPS placement and 4.3 ± 1.8 mm Hg (range, 2-8 mm Hg) after TIPS placement. Five patients (50%) underwent adjunctive embolization of stomal varices through the TIPS, which did not affect outcome. Complications included one patient each with a contrast allergy and renal failure. Six patients experienced complete resolution of bleeding without further intervention (60%). Four patients had recurrent stomal hemorrhage. Two of the four needed TIPS revision for occlusion; one underwent oversewing of the ostomy; and in one the hemorrhage resolved with conservative measures after confirmation of TIPS patency.
  
  
  CONCLUSIONS
  TIPS creation, with or without adjunctive variceal embolization, is a safe and effective treatment of refractory hemorrhagic stomal varices. Reintervention for recurrent bleeding may be required and appears effective.
authors.affiliation: 1 Division of Vascular and Interventional Radiology, Department of Radiology, New York University Medical Center, 660 First Ave, 7th Fl, New York, NY 10016.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Deipolyi
authors.forename: Sanjeeva P
authors.initials: SP
authors.lastname: Kalva
authors.forename: Rahmi
authors.initials: R
authors.lastname: Oklu
authors.forename: T Gregory
authors.initials: TG
authors.lastname: Walker
authors.forename: Stephan
authors.initials: S
authors.lastname: Wicky
authors.forename: Suvranu
authors.initials: S
authors.lastname: Ganguli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D016896:Treatment Outcome
keywords: TIPS; embolization; portal hypertension; stomal varices; transjugular intrahepatic portosystemic shunt