Preemptive‐TIPS Improves Outcome in High‐Risk Variceal Bleeding: An Observational Study

  • Virginia Hernández‐Gea
    Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic‐Institut d’Investigacions Biomèdiques August Pi I i Sunyer, IMDIM,University of Barcelona,Barcelona,Spain
  • Bogdan Procopet
    Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Hepatology Department and “Iuliu Hatieganu” University of Medicine and Pharmacy, 3rd Medical Clinic,Cluj‐Napoca,Romania
  • Álvaro Giráldez
    Clinical Management Unit of Digestive Diseases,University Hospital Virgen del Rocio,Seville,Spain
  • Lucio Amitrano
    Gastroenterology Unit,Ospedale A Cardarelli,Naples,Italy
  • Candid Villanueva
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Dominique Thabut
    Groupement Hospitalier Pitié‐Salpêtrière‐Charles Foix,Paris,France
  • Luis Ibañez‐Samaniego
    Servicio de Medicina de Aparato Digestivo Gregorio Marañón,Hospital General Universitario Gregorio Marañón,liSGM,CIBERehd,Barcelona,Spain
  • Gilberto Silva‐Junior
    Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic‐Institut d’Investigacions Biomèdiques August Pi I i Sunyer, IMDIM,University of Barcelona,Barcelona,Spain
  • Javier Martinez
    Department of Gastroenterology,Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, CIBERehd,Madrid,Spain
  • Joan Genescà
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Christophe Bureau
    Department of Hepato‐Gastroenterology,Purpan Hospital, CHU Toulouse,INSERM U858,University of Toulouse,France,Toulouse,France
  • Jonel Trebicka
    Department of Internal Medicine I,University of Bonn,Bonn,Germany
  • Elba Llop
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Wim Laleman
    Department of Liver and Biliopancreatic Disorders,University of Leuven,Leuven,Belgium
  • Jose Maria Palazon
    Hospital General Universitario de Alicante,Alicante,Spain
  • Jose Castellote
    Gastroenterology Department, Hepatology Unit,Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona,Barcelona,Spain
  • Susana Rodrigues
    Gastroenterology and Hepatology Department,Centro Hospitalar São João,Porto,Portugal
  • Lise L. Gluud
    Gastrounit, Medical Division,University Hospital of Hvidovre,Faculty of Health and Medical Sciences,University of Copenhagen,Copenhagen,Denmark
  • Carlos Noronha Ferreira
    Serviço de Gastrenterologia e Hepatologia,Hospital de Santa Maria ‐ Centro Hospitalar Lisboa Norte,Lisbon,Portugal
  • Rafael Barcelo
    Medical Statistics Core Facility, Institut D’Investigacions Biomédiques August Pi i Sunyer,Hospital Clinic Barcelona,Barcelona,Spain
  • Nuria Cañete
    Liver Section, Gastroenterology Department, Hospital del Mar,Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute),Barcelona,Spain
  • Manuel Rodríguez
    Department of Gastroenterology,Hospital Central de Asturias,Oviedo,Spain
  • Arnulf Ferlitsch
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology,Medical University of Vienna,Vienna,Austria
  • Jose Luis Mundi
    Department of Gastroenterology,University Hospital San Cecilio,Granada,Spain
  • Henning Gronbaek
    Department of Hepatology and Gastroenterology,Aarhus University Hospital,Aarhus,Denmark
  • Manuel Hernández‐Guerra
    Gastroenterology Department,University Hospital of the Canary Islands,La Laguna,Tenerife,Spain
  • Romano Sassatelli
    Unit of Gastroenterology and Digestive Endoscopy,Arcispedale Santa Maria Nuova‐IRCCS,Reggio Emilia,Italy
  • Alessandra Dell’Era
    Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences,University of the Studies of Milan,Milan,Italy
  • Marco Senzolo
    Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology,University Hospital of Padua,Padua,Italy
  • Juan G. Abraldes
    Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), CEGIIR,University of Alberta,Edmonton,Canada
  • Manuel Romero‐Gómez
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Alexander Zipprich
    First Department of Internal Medicine,Martin Luther University Halle‐Wittenberg,Halle (Saale),Germany
  • Meritxell Casas
    Hepatology Unit, Digestive Disease Department Hospital de Sabadell,Universitat Autónoma de Barcelona,Sabadell,Spain
  • Helena Masnou
    Hospital Universitari Germans Trias i Pujol,Universitat Autònoma Barcelona,Badalona,Spain
  • Massimo Primignani
    Division of Gastroenterology and Hepatology,IRCCS Ca’ Granda Maggiore Hospital Foundation, University of Milan,Milan,Italy
  • Aleksander Krag
    Department of Gastroenterology and Hepatology,Odense University Hospital,Odense,Denmark
  • Frederik Nevens
    Department of Liver and Biliopancreatic Disorders,University of Leuven,Leuven,Belgium
  • Jose Luis Calleja
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Christian Jansen
    Department of Internal Medicine I,University of Bonn,Bonn,Germany
  • Marie Angèle Robic
    Department of Hepato‐Gastroenterology,Purpan Hospital, CHU Toulouse,INSERM U858,University of Toulouse,France,Toulouse,France
  • Irene Conejo
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Maria‐Vega Catalina
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Agustin Albillos
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Marika Rudler
    Groupement Hospitalier Pitié‐Salpêtrière‐Charles Foix,Paris,France
  • Edilmar Alvarado
    Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
  • Maria Anna Guardascione
    Gastroenterology Unit,Ospedale A Cardarelli,Naples,Italy
  • Marcel Tantau
    Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Hepatology Department and “Iuliu Hatieganu” University of Medicine and Pharmacy, 3rd Medical Clinic,Cluj‐Napoca,Romania
  • Jaime Bosch
    Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic‐Institut d’Investigacions Biomèdiques August Pi I i Sunyer, IMDIM,University of Barcelona,Barcelona,Spain
  • Ferran Torres
    Medical Statistics Core Facility, Institut D’Investigacions Biomédiques August Pi i Sunyer,Hospital Clinic Barcelona,Barcelona,Spain
  • Juan Carlos Garcia‐Pagán
    Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic‐Institut d’Investigacions Biomèdiques August Pi I i Sunyer, IMDIM,University of Barcelona,Barcelona,Spain

抄録

<jats:p>Patients admitted with acute variceal bleeding (AVB) and Child‐Pugh C score (CP‐C) or Child‐Pugh B plus active bleeding at endoscopy (CP‐B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p‐TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high‐risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p‐TIPS was based on individual center policy. p‐TIPS in the setting of AVB is associated with a lower mortality in CP‐C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; <jats:italic toggle="yes">P</jats:italic> = 0.002). Mortality rate in CP‐B+AB patients was low, and p‐TIPS did not improve it. In CP‐C and CP‐B+AB patients, p‐TIPS reduced treatment failure and rebleeding (1‐year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; <jats:italic toggle="yes">P</jats:italic> = 0.017) and development of <jats:italic toggle="yes">de novo</jats:italic> or worsening of previous ascites without increasing rates of hepatic encephalopathy. <jats:italic toggle="yes">Conclusion: </jats:italic>p‐TIPS must be the treatment of choice in CP‐C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p‐TIPS could be a good treatment strategy for CP‐B+AB patients.</jats:p>

収録刊行物

  • Hepatology

    Hepatology 69 (1), 282-293, 2018-12-10

    Ovid Technologies (Wolters Kluwer Health)

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