Early‐TIPSS placement prevents rebleeding in high‐risk patients with variceal bleeding, without improving survival. Issue 9 (17th September 2014)

• Record Type: Journal Article
• Authors: Rudler, M.; Cluzel, P.; Corvec, T. L.; Benosman, H.; Rousseau, G.; Poynard, T.; Thabut, D.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 40:Issue 9(2014)
• Page Start: 1074
• Page End: 1080
• Publication Date: 2014-09-17
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12934
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12934-abs-0001"> <title>Summary</title> <sec id="apt12934-sec-0001" sec-type="section"> <title>Background</title> <p>Early‐TIPSS (transjugular intrahepatic portosystemic shunt) placement may improve rebleeding and reduce 1‐year mortality, compared to standard management in high‐risk patients with cirrhosis and variceal bleeding.</p> </sec> <sec id="apt12934-sec-0002" sec-type="section"> <title>Aim</title> <p>To obtain external validation of this therapeutic approach.</p> </sec> <sec id="apt12934-sec-0003" sec-type="section"> <title>Methods</title> <p>We performed a prospective study including all consecutive patients with Child–Pugh C 10–13 cirrhosis or Child–Pugh B with active bleeding at endoscopy admitted to our ICU between March 2011 and February 2013 for variceal bleeding. TIPSS were placed within 72 h after stabilisation. Patients were matched for gender, age, Child–Pugh score, MELD score and to patients from a historical cohort hospitalised before March 2011.</p> </sec> <sec id="apt12934-sec-0004" sec-type="section"> <title>Results</title> <p>31/128 patients with cirrhosis (77.4% men, mean age 53.2 ± 9.0 years old, MELD score 20.9 ± 6.9, Child–Pugh C: 77.4%) admitted for acute variceal bleeding between March 2011 and February 2013 (TIPSS+ group) were matched to 31 historical patients (TIPSS− group). Uncontrolled bleeding occurred in 1/31 patients in the TIPSS+ group vs. 2/31 patients in TIPSS− group (<italic>P</italic> = 0.55). The 1‐year probability of being free of rebleeding was higher in the TIPSS+ group (97% vs. 51%, <italic>P</italic> < 0.001). Actuarial 1‐year survival was not different between the two groups (66.8 ± 9.4% vs. 74.2 ± 7.8%, <italic>P</italic> = 0.78). Acute cardiac failure occurred more frequently in the TIPSS+ group (25.8% vs. 6.4%, <italic>P</italic> = 0.03).</p> </sec> <sec id="apt12934-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Early‐TIPSS placement effectively prevents rebleeding in high‐risk patients with variceal bleeding but does not significantly improve survival. This might be due to the high proportion of patients with Child–Pugh C cirrhosis in our series. Cardiac failure may play a role and must be investigated before the procedure, when possible.</p> </sec> </abstract>