title: [Safety and clinical efficacy of TIPS with various stents for treatment of cirrhosis with esophageal gastric varices bleeding].
abstract: OBJECTIVE
  To assess the safety and clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with various stents for treating patients with cirrhosis and esophageal gastric varices bleeding.
  
  
  METHODS
  One hundred and five patients were stratified according to stent type: bare stent group, covered stent-grafts group, combined stents group. Rates of success, shunt insufficiency, rebleeding, patient survival, and major complications were observed. The shunt insufficiency rate, rebleeding rate, and survival rate were calculated by the life tables method, the Kaplan-Meier analytical curve, and the log-rank test; a p-value less than 0.05 was considered statistically significant.
  
  
  RESULTS
  The overall success rate of all TIPS for treating the esophageal gastric varices bleeding was 100%. The overall shunt insufficiency rates at 6-, 12-and 24-months post-TIPS were 8%, 9% and 16%, rebleeding rates were 2%, 6% and 17%, and survival rates were 100%, 97% and 94%. The shunt insufficiency rate was 26% in the bare stent group, 14% in the covered stent-grafis group, and 5% in the combined stents group (x2=1.00, P=0.61). The rebleeding rate was 33% in the bare stent group, 7% in the covered stent-grafts group, and 3%in the combined stents group (x2=1.69, P=0.43). The survival rate was 92% in the bare stent group, 93% in the covered stent-grafts group, and 100% in the combined stents group (x2=1.91, P=0.39). The shunt insufficiency rates were higher in patients with splenectomy than in those without splenectomy (30% vs.14%; x2=4.15, P=0.04). The intraperitoneal hemorrhage rates in the covered stent-grafis group and the combined stents group were significantly lower than that in the bare stent group (0% vs 0% vs 13%; x2=8.88, P=0.01).
  
  
  CONCLUSIONS
  TIPS with an 8 mm stent effectively treated and prevented esophageal gastric varices bleeding in patients with cirrhosis. Intraperitoneal hemorrhaging caused by TIPS was significantly decreased in the covered stent-grafts group and combined stents group,which represented an improvement in safety of this treatment. However, the influence of covered stent-grafis and combined stents towards the clinical efficacy of TIPS needs further study.
authors.affiliation: Department of Gastroenterology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
authors.forename: Yuzheng
authors.initials: Y
authors.lastname: Zhuge
authors.forename: Jianwu
authors.initials: J
authors.lastname: Zhang
authors.forename: Zhenlei
authors.initials: Z
authors.lastname: Li
authors.forename: Qibin
authors.initials: Q
authors.lastname: He
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
authors.forename: Jingbin
authors.initials: J
authors.lastname: Ni
authors.forename: Yujiang
authors.initials: Y
authors.lastname: Li
authors.forename: Qianyun
authors.initials: Q
authors.lastname: Ma
authors.forename: Chunyan
authors.initials: C
authors.lastname: Peng
mesh_terms: D004935:Esophageal Diseases; D004932:Esophageal and Gastric Varices; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015607:Stents; D015996:Survival Rate