Bleeding ectopic varices due to cirrhosis can be difficult to manage.
Researchers from London, UK carried out a report on the treatment of uncontrolled bleeding from ectopic varices with transjugular intrahepatic porto-systemic shunt (TIPS).
The research group selected 21 cirrhotics from their database to be treated with TIPS for bleeding ectopic varices: Child-Pugh grade A (2), B (11) and C (8).
The sites of bleeding were: rectal (11), colonic (2), ileal 1, jejunal 1, duodenal 1, and stomal (5).
The researchers performed TIPS successfully in 19/21 (90%) patients.
All except 1 had either a reduction in portosystemic pressure gradient ≤ 12mmHg or reduction by 25–50% of baseline.
The researchers used TIPS alone in 12/19 patients.
They research group found that 7 of these 12 had no further bleeding; 5 (42%) rebled within 48h, and had embolization, 4 without further bleeding.
| Embolization stopped bleeding in all but 1 patient|
|Journal of Hepatology|
The researchers then performed TIPS and embolization together in 7 of the 19 patients.
They found that 2 patients (28%) rebled, but further embolization stopped the bleeding.
Dr David Patcha concluded, "Ectopic varices do rebleed despite a reduction of porto-systemic pressure gradient ≤ 12mmHg or by 25–50% of baseline, following TIPS."
"Embolization stopped bleeding in all but 1 patient."
The group commented, "We recommend performing embolization at the time of the initial TIPS to control bleeding from ectopic varices."