The investigators compared endoscopic variceal ligation (EVL) plus propranolol with transjugular intrahepatic portosystemic stent shunt (TIPS) for the prevention of variceal rebleeding.
They reported their findings in the September issue of Endoscopy.
A total of 85 patients were randomly allocated to receive TIPS (n = 43) or EVL (n = 42).
The groups were comparable regarding age, sex, etiology of liver cirrhosis, and liver function.
The mean observation times were 4.1 years in the TIPS group and 3.6 years in the EVL group.
Although the probability of rebleeding was higher in the EVL group (30%) than in the TIPS group (19%), the difference was not found to be statistically significant.
| TIPS dysfunction requiring shunt revision occurred in 89% of cases.
| Endoscopy |
The authors found that 3 of 5 patients of the EVL group successfully underwent TIPS placement after treatment failure.
The probability of TIPS dysfunction requiring shunt revision was 89%.
Hepatic encephalopathy was observed more often in the TIPS group (41%) than in the EVL group (21%).
However, the probability of survival was similar in both groups (TIPS group 76%, EVL group 82%).
Author P. Sauer, of the University of Heidelberg concluded on behalf of the group, "In view of its good efficacy and the lower cost of treatment, endoscopic ligation plus propranolol may be recommended as initial procedure for prevention of recurrent variceal hemorrhage.
"On the other hand, TIPS seems to be the preferable procedure in patients with recurrent bleeding after adequate endoscopic and pharmacological treatment."