Preemptive‐TIPS Improves Outcome in High‐Risk Variceal Bleeding: An Observational Study
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- 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
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- 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
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- Álvaro Giráldez
- Clinical Management Unit of Digestive Diseases,University Hospital Virgen del Rocio,Seville,Spain
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- Lucio Amitrano
- Gastroenterology Unit,Ospedale A Cardarelli,Naples,Italy
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- Candid Villanueva
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Dominique Thabut
- Groupement Hospitalier Pitié‐Salpêtrière‐Charles Foix,Paris,France
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- Luis Ibañez‐Samaniego
- Servicio de Medicina de Aparato Digestivo Gregorio Marañón,Hospital General Universitario Gregorio Marañón,liSGM,CIBERehd,Barcelona,Spain
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- 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
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- Javier Martinez
- Department of Gastroenterology,Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, CIBERehd,Madrid,Spain
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- Joan Genescà
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Christophe Bureau
- Department of Hepato‐Gastroenterology,Purpan Hospital, CHU Toulouse,INSERM U858,University of Toulouse,France,Toulouse,France
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- Jonel Trebicka
- Department of Internal Medicine I,University of Bonn,Bonn,Germany
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- Elba Llop
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Wim Laleman
- Department of Liver and Biliopancreatic Disorders,University of Leuven,Leuven,Belgium
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- Jose Maria Palazon
- Hospital General Universitario de Alicante,Alicante,Spain
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- Jose Castellote
- Gastroenterology Department, Hepatology Unit,Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona,Barcelona,Spain
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- Susana Rodrigues
- Gastroenterology and Hepatology Department,Centro Hospitalar São João,Porto,Portugal
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- Lise L. Gluud
- Gastrounit, Medical Division,University Hospital of Hvidovre,Faculty of Health and Medical Sciences,University of Copenhagen,Copenhagen,Denmark
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- Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia,Hospital de Santa Maria ‐ Centro Hospitalar Lisboa Norte,Lisbon,Portugal
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- Rafael Barcelo
- Medical Statistics Core Facility, Institut D’Investigacions Biomédiques August Pi i Sunyer,Hospital Clinic Barcelona,Barcelona,Spain
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- Nuria Cañete
- Liver Section, Gastroenterology Department, Hospital del Mar,Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute),Barcelona,Spain
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- Manuel Rodríguez
- Department of Gastroenterology,Hospital Central de Asturias,Oviedo,Spain
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- Arnulf Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology,Medical University of Vienna,Vienna,Austria
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- Jose Luis Mundi
- Department of Gastroenterology,University Hospital San Cecilio,Granada,Spain
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- Henning Gronbaek
- Department of Hepatology and Gastroenterology,Aarhus University Hospital,Aarhus,Denmark
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- Manuel Hernández‐Guerra
- Gastroenterology Department,University Hospital of the Canary Islands,La Laguna,Tenerife,Spain
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- Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy,Arcispedale Santa Maria Nuova‐IRCCS,Reggio Emilia,Italy
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- Alessandra Dell’Era
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences,University of the Studies of Milan,Milan,Italy
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- Marco Senzolo
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology,University Hospital of Padua,Padua,Italy
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- Juan G. Abraldes
- Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), CEGIIR,University of Alberta,Edmonton,Canada
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- Manuel Romero‐Gómez
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Alexander Zipprich
- First Department of Internal Medicine,Martin Luther University Halle‐Wittenberg,Halle (Saale),Germany
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- Meritxell Casas
- Hepatology Unit, Digestive Disease Department Hospital de Sabadell,Universitat Autónoma de Barcelona,Sabadell,Spain
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- Helena Masnou
- Hospital Universitari Germans Trias i Pujol,Universitat Autònoma Barcelona,Badalona,Spain
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- Massimo Primignani
- Division of Gastroenterology and Hepatology,IRCCS Ca’ Granda Maggiore Hospital Foundation, University of Milan,Milan,Italy
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- Aleksander Krag
- Department of Gastroenterology and Hepatology,Odense University Hospital,Odense,Denmark
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- Frederik Nevens
- Department of Liver and Biliopancreatic Disorders,University of Leuven,Leuven,Belgium
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- Jose Luis Calleja
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Christian Jansen
- Department of Internal Medicine I,University of Bonn,Bonn,Germany
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- Marie Angèle Robic
- Department of Hepato‐Gastroenterology,Purpan Hospital, CHU Toulouse,INSERM U858,University of Toulouse,France,Toulouse,France
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- Irene Conejo
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Maria‐Vega Catalina
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Agustin Albillos
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Marika Rudler
- Groupement Hospitalier Pitié‐Salpêtrière‐Charles Foix,Paris,France
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- Edilmar Alvarado
- Centro de Investigación Biomédica Red de enfermedades hepáticas y digestivas,Madrid,Spain
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- Maria Anna Guardascione
- Gastroenterology Unit,Ospedale A Cardarelli,Naples,Italy
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- 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
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- 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
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- Ferran Torres
- Medical Statistics Core Facility, Institut D’Investigacions Biomédiques August Pi i Sunyer,Hospital Clinic Barcelona,Barcelona,Spain
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- 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
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- Hepatology
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Hepatology 69 (1), 282-293, 2018-12-10
Ovid Technologies (Wolters Kluwer Health)