The researchers compared the efficacy, safety, and cost of transjugular intrahepatic portosystemic shunt (TIPS) versus pharmacologic therapy in preventing variceal rebleeding in patients with advanced cirrhosis.
The findings of the study were reported in the February issue of Hepatology.
A total of 91 Child-Pugh class B/C cirrhotic patients, surviving their first episode of variceal bleeding, were included in the trial.
The patients were randomized to receive TIPS (n = 47) or drug therapy (propranolol and isosorbide-5-mononitrate, n = 44) to prevent variceal rebleeding.
After a mean follow-up of 15 months, rebleeding occurred in 6 (13%) TIPS-treated patients versus 17 (39%) drug-treated patients.
The 2-year rebleeding probability was 13% versus 49%, respectively.
|2-year rebleeding probability:|
Drug therapy: 49%
| Hepatology |
A similar number of reinterventions were required in the two groups. These were mainly angioplasty with or without restenting in the TIPS group (90/98), and endoscopic therapy for rebleeding in the medical group (45/62).
The researchers found that encephalopathy was more frequent in TIPS than in drug-treated patients (38% vs 14%).
In addition, Child-Pugh class improved more frequently in drug-treated than in TIPS-treated patients (72% vs 45%).
The 2-year survival probability was identical (72%) for the two groups.
The identified cost of therapy was found to be double for TIPS-treated patients.
Àngels Escorsell said on behalf of fellow authors, "Medical therapy was less effective than TIPS in preventing rebleeding.
"However, it caused less encephalopathy, identical survival, and more frequent improvement in Child-Pugh class with lower costs, than TIPS in high-risk cirrhotic patients."
"This suggests that TIPS should not be used as a first-line treatment, but as a rescue for failures of medical and endoscopic treatments," it was concluded.