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 22 November 2017

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Follow-up of transjugular intrahepatic portosystemic stent-shunt insertion

Doctors, in the January issue of the European Journal of Gastroenterology and Hepatology, find that transjugular intrahepatic portosystemic stent-shunt insertion is effective in the management of variceal bleeding.

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Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is increasingly used for the management of portal hypertension.

In this study, doctors from Scotland report their experience of 10 years at a single center.

The team analyzed data on 497 patients referred for TIPSS to assess the efficacy of TIPSS and its complications.

The team found that the majority of patients were male (59%) with alcoholic liver disease (64%), and bleeding varices (87%).

They determined that technical success was achieved in 95% patients.
Procedure-related mortality was 1%.
European Journal of Gastroenterology and Hepatology

They found that 13% of patients bled at portal pressure gradients ≤12 mmHg, principally from gastric and ectopic varices.

The doctors calculated primary shunt patency rates as 45% and 26% at 1 and 2 years, respectively. The overall secondary assisted patency rate was 72%.

Variceal rebleeding rate was 14%. All rebleeding episodes occurred within 2 years of TIPSS insertion. The majority were due to shunt dysfunction.

The team found that the overall mortality rate was 60%, mainly due to end-stage liver failure (43%).

They determined that patients who bled from gastric varices had lower mortality than those from esophageal varices (54% versus 62%).

In addition, they found that the overall rate of hepatic encephalopathy was 30%. Pre-TIPSS encephalopathy was an independent predicting variable of hepatic encephalopathy.

Refractory ascites responded to TIPSS in 72% of cases.

Dr Dhiraja Tripathi's team concluded, "TIPSS is effective in the management of variceal bleeding, and has a low complication rate".

"With surveillance, good patency can be achieved. Careful selection of patients is needed to reduce the encephalopathy rate".

Eur J Gastroenterol Hepatol 2004; 16(1): 9-18
12 December 2003

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