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News

TIPS and embolization recommended to control bleeding ectopic varices

Embolization at the time of initial transjugular intrahepatic porto-systemic shunt (TIPS) is recommended to control bleeding from ectopic varices, reports October's Journal of Hepatology.

News image

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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."

Journal of Hepatology; 2004: 41 (4): 560-566
05 October 2004

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