The team compared the two-year survival and re-bleeding rates in cirrhotic patients treated by either variceal band ligation or transjugular intrahepatic portosystemic shunt (TIPS) for variceal bleeding.
Eighty cirrhotic patients with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding.
Mean follow-up was 581 days in the ligation group and 678 days in the TIPS group.
|Incidence of variceal re-bleeding after two years, following procedure:|
The researchers found that the two-year survival rate was 57% in the TIPS group and 56% in the ligation group. The incidence of variceal re-bleeding after two years was 18% in the TIPS group and 66% in the ligation group.
Uncontrolled re-bleeding occurred in 11 patients in the ligation group (eight were rescued by emergency TIPS), but in none of the TIPS group.
The incidence of encephalopathy at two years was 47% in the TIPS group and 44% in the ligation group.
Dr G Pomier-Layrargues of the Hôpital Saint-Luc, Montréal said on behalf of the group, "TIPS did not increase the two-year survival rate compared with variceal band ligation after variceal bleeding in cirrhotic patients with moderate or severe liver failure.
"However, it significantly reduced the incidence of variceal re-bleeding without increasing the rate of encephalopathy."