title: Second prophylaxis of variceal bleeding in cirrhotic patients with a high HVPG.
abstract: OBJECTIVE
  The hepatic venous pressure gradient (HVPG) could be used to stratify patients in different risk groups. No studies have reported the role of transjugular intrahepatic portosystemic shunt (TIPS) placement in a subgroup of patients with a high HVPG (≥20 mmHg) for secondary prophylaxis of variceal bleeding. This study was designed to evaluate the benefit of TIPS in cirrhotic patients with a high HVPG (≥20 mmHg) for rebleeding and survival.
  
  
  METHODS
  We included 46 cirrhotic patients with a history of variceal bleeding and a high HVPG (≥20 mmHg) admitted to our hospital between January 2013 and June 2014 (TIPS group). Patients were matched by Child-Pugh scores to patients in our historical cohort hospitalized for prophylaxis of variceal rebleeding between April 2011 and December 2012 (propranolol + EVL group). The end points included time to significant rebleeding from portal hypertensive sources, 1-year survival, and time to the occurrence of hepatic encephalopathy (HE).
  
  
  RESULTS
  The 1-year actuarial probability of remaining free of variceal rebleeding was significantly higher in the TIPS group than in the propranolol + EVL group (85% vs. 54%, p = 0.01). The 1-year survival rates were not different between the two groups (85% vs. 89%, p = 0.591). The 1-year actuarial probability of remaining free of HE was significantly lower in the TIPS group than in the propranolol + EVL group (67% vs. 91%, p = 0.003).
  
  
  CONCLUSIONS
  TIPS was more effective than propranolol + EVL in preventing variceal rebleeding in cirrhotic patients with a high HVPG (≥20 mmHg). During the limited follow-up, survival was similar in the two groups.
authors.affiliation: a Department of Digestive Internal Medicine , Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , PR China.
authors.forename: Mingyan
authors.initials: M
authors.lastname: Zhang
authors.affiliation: a Department of Digestive Internal Medicine , Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , PR China.
authors.forename: Guangchuan
authors.initials: G
authors.lastname: Wang
authors.affiliation: a Department of Digestive Internal Medicine , Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , PR China.
authors.forename: Lianhui
authors.initials: L
authors.lastname: Zhao
authors.affiliation: a Department of Digestive Internal Medicine , Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , PR China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wu
authors.affiliation: a Department of Digestive Internal Medicine , Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , PR China.
authors.forename: Wenxing
authors.initials: W
authors.lastname: Zhang
authors.affiliation: a Department of Digestive Internal Medicine , Shandong Provincial Hospital Affiliated to Shandong University , Jinan , Shandong , PR China.
authors.forename: Chunqing
authors.initials: C
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D006501:Hepatic Encephalopathy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods*; D011433:Propranolol / Q000627:therapeutic use*; D055502:Secondary Prevention; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D011433:Propranolol
keywords: Hepatic encephalopathy; individualized treatment; second prophylaxis; survival; variceal bleeding