title: Transjugular intrahepatic portosystemic shunt combined with esophagogastric variceal embolization in the treatment of a large gastrorenal shunt.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with stomach and esophageal variceal embolization (SEVE) in cirrhotic patients with a large gastrorenal vessel shunt (GRVS).
  
  
  METHODS
  Eighty-one cirrhotic patients with gastric variceal bleeding (GVB) associated with a GRVS were enrolled in the study and accepted TIPS combined with SEVE (TIPS + SEVE), by which portosystemic pressure gradient (PPG), biochemical, TIPS-related complications, shunt dysfunction, rebleeding, and death were evaluated.
  
  
  RESULTS
  The PPGs before TIPS were greater than 12 mmHg in 81 patients. TIPS + SEVE treatment caused a significant decrease in PPG (from 37.97 ± 6.36 mmHg to 28.15 ± 6.52 mmHg, t = 19.22, P < 0.001). The percentage of reduction in PPG was greater than 20% from baseline. There were no significant differences in albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time, or Child-Pugh score before and after operation. In all patients, rebleeding rates were 3%, 6%, 12%, 18%, and 18% at 1, 3, 6, 12, and 18 mo, respectively. Five patients (6.2%) were diagnosed as having hepatic encephalopathy. The rates of shunt dysfunction were 0%, 4%, 9%, 26%, and 26%, at 1, 3, 6, 12, and 18 mo, respectively. The cumulative survival rates in 1, 3, 6, 12, and 18 mo were 100%, 100%, 95%, 90%, and 90%, respectively.
  
  
  CONCLUSIONS
  Our preliminary results indicated that the efficacy and safety of TIPS + SEVE were satisfactory in cirrhotic patients with GVB associated with a GRVS (GVB + GRVS).
authors.affiliation: Qin Jiang, Department of Gastroenterology, 161 Hospital of Chinese People's Liberation Army, Wuhan 430000, Hubei Province, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: Qin Jiang, Department of Gastroenterology, 161 Hospital of Chinese People's Liberation Army, Wuhan 430000, Hubei Province, China.
authors.forename: Ming-Quan
authors.initials: MQ
authors.lastname: Wang
authors.affiliation: Qin Jiang, Department of Gastroenterology, 161 Hospital of Chinese People's Liberation Army, Wuhan 430000, Hubei Province, China.
authors.forename: Guo-Bing
authors.initials: GB
authors.lastname: Zhang
authors.affiliation: Qin Jiang, Department of Gastroenterology, 161 Hospital of Chinese People's Liberation Army, Wuhan 430000, Hubei Province, China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Qin Jiang, Department of Gastroenterology, 161 Hospital of Chinese People's Liberation Army, Wuhan 430000, Hubei Province, China.
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Xu
authors.affiliation: Qin Jiang, Department of Gastroenterology, 161 Hospital of Chinese People's Liberation Army, Wuhan 430000, Hubei Province, China.
authors.forename: De-Run
authors.initials: DR
authors.lastname: Kong
keywords: Cirrhosis; Gastric varices; Gastrorenal shunt; Transjugular intrahepatic portosystemic shunt; Variceal embolization