Comparative Study On The Efficacy Of TIPS And EVL In The Treatment Of Esophageal-Gastric Variceal Bleeding In Cirrhosis

Objective: The objective of this study is to compare the clinical efficacy and prognosis of the Transjugular Intrahepatic Portosystemic Shunt(TIPS)and the Endoscopic Variceal Ligation(EVL)in the treatment for Esophageal-Gastric Variceal Bleeding(EGVB)patients with cirrhosis,and to further analyze the advantages and disadvantages of TIPS and EVL.Methods: The patients with cirrhosis of the esophagus varices(EV)who were treated with TIPS and EVL in our hospital from January 2018 to December 2020 were retrospectively analyzed.They were divided into three groups according to the treatment methods: 104 cases in the TIPS group,106 cases in the EVL group,and 80 cases in the EVL+TIPS group,respectively.The baseline information,laboratory indicators,clinical efficacy,rebleeding rate,survival rate and complications of patients in the three groups were compared.SPSS was adopted for analysis and conclusions.Results: There is no significant difference in baseline information among the three groups(P> 0.05).MELD score was higher in the TIPS group and EVL+TIPS group than in the EVL group Child-pugh score is higher in the EVL+TIPS group than in the EVL group after treatment.Compared with the EVL group,the TIPS group and EVL+TIPS group has higher EV disappearance rate and improvement rate but lower inefficiency(15.38%,16.25% vs 4.72%;76.92%,73.75% vs33.02 %;2.88%,3.75% vs60.38%);The mean bleeding time was 185 days,110.56 days and 192.5 days in the three groups,respectively.There is significant difference in one-year cumulative rebleeding rate among TIPS group,EVL+TIPS group and EVL group(97.1% vs 97.5%vs 75.5%,χ2=36.946,P=0.000,log-rank test).There is no significant difference in one-year cumulative survival rate among TIPS group,EVL group and EVL+TIPS group(92.3%vs89.6%vs86.3%,χ2 =1.827,P=0.401,log-rank test).The incidence of hepatic encephalopathy is higher in the TIPS group and EVL+TIPS group than in the EVL group(24.04% vs.31.25% vs.2.83%).Conclusions: Both TIPS and EVL treatment have good hemostasis effect.TIPS greatly alleviates the degree of EV and has significant advantages in the prevention of rebleeding.In addition,regardless of whether EVL treatment has been adopted before TIPS,TIPS have good hemostasis effect and the ability of preventing rebleeding,however,the probability of complicating hepatic encephalopathy is 27.17% for TIPS,which is higher than EVL(2.83%).