TIPS vs endoscopic treatment for prevention of recurrent variceal bleeding: A long-term follow-up of 126 patients

  • Špela Koršič MD Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.
  • prof. Borut Štabuc, MD, PhD Department of Gastroenterology and Hepatology, University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.
  • prof. Pavel Skok MD, PhD Department of Gastroenterology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
  • assoc. prof. Peter Popovič, MD, PhD Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.

Abstract

Background

Recurrent bleeding from gastroesophageal varices is the most common life-threatening complication of portal hypertension. According to guidelines, transjugular intrahepatic portosystemic shunt (TIPS) should not be used as a first-line treatment and should be limited to those bleedings which are refractory to pharmacologic and endoscopic treatment (ET). To our knowledge, long-term studies evaluating the role of elective TIPS in comparison to ET in patients with recurrent variceal bleeding episodes are rare.

 

Patients and methods

This study was designed as a retrospective single-institution analysis of 70 patients treated with TIPS and 56 with ET. Patients were followed-up from inclusion in the study until death, liver transplantation, the last follow-up observation or until the end of our study.

 

Results

Recurrent variceal bleeding was significantly more frequent in ET group compared to patients TIPS group (66.1% vs21.4%, p < 0.001; χ2-test). The incidence of death secondary to recurrent bleeding was higher in the ET group (28.6% vs10%). Cumulative survival after 1 year, 2 years and 5 years in TIPS group compared to ET group was 85% vs 83%, 73% vs 67% and 41% vs 35%. The main cause of death in patients with cumulative survival more than 2 years was liver failure. Median observation time was 47 months (range; 2-194 months) in the TIPS group and 40 months (range; 1-168 months) in the ET group.

 

Conclusion

TIPS is more effective in the prevention of recurrent variceal bleeding and has lower mortality due to recurrent variceal bleeding compared to ET.

Published
2021-04-27
How to Cite
Koršič, Špela, Štabuc, B., Skok, P., & Popovič, P. (2021). TIPS vs endoscopic treatment for prevention of recurrent variceal bleeding: A long-term follow-up of 126 patients. Radiology and Oncology, 55(2), 164-171. Retrieved from https://www.radioloncol.com/index.php/ro/article/view/3605
Section
Radiology