Percutaneous Transhepatic Variceal Embolization With TH Glue Versus Transjugular Intrahepatic Portosystemic Shunt In Esophage-gastric Variceal Bleeding Management

Objective:In recent years, conventional percutaneous transhepatic varices embolization (PTVE) has rarely been used due to high rates of variceal recurrence and rebleeding. Here in our report,a modified PTVE with TH glue has been used. We compared this modified-PTVE with transjugular intrahepatic systemic shunt(TIPS)in the treatment of esophagogastric variceal bleeding in this article,in order to know the value of PTVE in the control of esophagogastric variceal bleeding.Methods:84 patients of liver cirrhosis with esophagogastric varices were included in this study(severe jaundice,portal vein thrombosis, hepatorenal failure,hepatocellular carcinoma,encephalopathy worse than stage II,heart failure were excluded),Color Doppler sonography and CT angiography helped to determine the detail of the varices and their feeding veins before operation.Every subject included in the study was followed until death, loss to follow up, or completion of the study。All patients in the PTVE and TIPS groups were not administered beta-blocker or other vasoactive drugs after procedures in this study. Endoscopy, Color Doppler sonography and CT scans together with angiography were needed in the follow-ups to determine the efficacy of the operation.Results:PTVE were performed on 46 patients,with a successful rate 100% (46/46).All patients were follow-up with a mean period of 24months.TIPS were performed on 38 patients,with a successful rate 100% (38/38).The probability of rebleeding of the upper gastrointestinal tract in the PTVE and TIPS group is 29.8% vs.23.4%(P=0.63,NS);the probability of encephalopathy is 16.4% vs.55.7% (P=0.00);the probability of survival is 84.3%vs.66.3%(P=0.141,NS). Conclusion:The clinical and follow-up result indicated that:(1)In controlling of variceal bleeding and the probability of survival, there was no significant difference in both PTVE and TIPS group.(2) After PTVE, liver function could be improved,but there is no improvement after TIPS;there was significantly fewer encephalopathy after TIPS than PTVE.Over all, we think PTVE is a valuable method in control of esophagogastric variceal bleeding.