title: Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding.
abstract: OBJECTIVE
  To compare transjugular intrahepatic portosystemic shunt (TIPS) placement with or without variceal embolization with endoscopic band ligation (EBL) plus propranolol in preventing recurrent esophageal variceal bleeding in patients with advanced cirrhosis and portal vein thrombosis.
  
  
  METHODS
  The present randomized controlled trial was approved by the ethics committee board of West China Hospital. Written informed consent was obtained from each patient. Between January 2010 and December 2012, 73 patients were randomly allocated to receive TIPS (n = 37) or EBL plus propranolol (n = 36). The comparisons of recurrent variceal bleeding, hepatic encephalopathy, and survival rates were based on the Kaplan-Meier method and were compared using the log-rank test.
  
  
  RESULTS
  The mean follow-up time was 22.8 months ± 7.7(standard deviation) in the TIPS group and 20.9 months ± 8.9 in the EBL group. The 2-year probability of remaining free of recurrent variceal bleeding was higher in the TIPS group (77.8%) than in the EBL group (42.9%) (P = .002). Overall recanalization was achieved in 24 (64.9%) patients from the TIPS group and seven (19.4%) patients from the EBL group. The hepatic encephalopathy rates exhibited no significant differences between the two groups (P = .53). The 1- and 2-year probability of survival was 86.5% and 72.9%, respectively, in the TIPS group and 83.3% and 57.2%, respectively, in the EBL group, with no significant difference (P = .23).
  
  
  CONCLUSIONS
  TIPS was more effective than EBL plus propranolol in preventing recurrent esophageal variceal bleeding in patients with advanced cirrhosis and portal vein thrombosis and did not increase the incidence of hepatic encephalopathy. Survival was similar in both groups.
authors.affiliation: From the Center of Interventional Radiology and Department of Gastroenterology, West China Hospital, Sichuan University, 37 Guoxue Lane, 610041 Chengdu, Sichuan, China.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Luo
authors.affiliation: From the Center of Interventional Radiology and Department of Gastroenterology, West China Hospital, Sichuan University, 37 Guoxue Lane, 610041 Chengdu, Sichuan, China.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Wang
authors.affiliation: From the Center of Interventional Radiology and Department of Gastroenterology, West China Hospital, Sichuan University, 37 Guoxue Lane, 610041 Chengdu, Sichuan, China.
authors.forename: Jiaywei
authors.initials: J
authors.lastname: Tsauo
authors.affiliation: From the Center of Interventional Radiology and Department of Gastroenterology, West China Hospital, Sichuan University, 37 Guoxue Lane, 610041 Chengdu, Sichuan, China.
authors.forename: Biao
authors.initials: B
authors.lastname: Zhou
authors.affiliation: From the Center of Interventional Radiology and Department of Gastroenterology, West China Hospital, Sichuan University, 37 Guoxue Lane, 610041 Chengdu, Sichuan, China.
authors.forename: Hailong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: From the Center of Interventional Radiology and Department of Gastroenterology, West China Hospital, Sichuan University, 37 Guoxue Lane, 610041 Chengdu, Sichuan, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013927:Thrombosis / Q000150:complications*
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol