Clinical Application Of Early TIPS In The Treatment Of Esophageal And Gastric Variceal Bleeding Due To Cirrhosis

Objective:To investigate the short-term and long-term effects of early transjugular intrahepatic portosystemic shunt(TIPS)and endoscopic treatment on esophagogastric variceal bleeding(EGVB)in cirrhotic portal hypertension(PHT).Methods:Data of 149 patients with EGVB in the interventional and endoscopic departments of the Second Affiliated Hospital of Kunming Medical University from January 2012 to December 2016 were collected.They were divided into early TIPS group(56 cases)and drug combined endoscopy group(93 cases)according to the treatment methods.The follow-up time was 1 week,1 month,3 months,6 months,1 year,2 years,3 years,and 93 cases.Five years later,hemostasis,laboratory indexes of liver function,rebleeding and occurrence of hepatic encephalopathy(HE)were compared between the two groups.Survival status of patients in two groups was observed.The data collection time was the closest to the follow-up period.Result:149 patients(male/female 103/46)with EGVB cirrhosis successfully completed TIPS or endoscopic treatment.Gastric Coronary Vein Embolization(GCVE)was performed during TIPS.In the early TIPS group,the age ranged from 30 to 88 years,the median age was 59 years,and Child-Pugh liver function grading was 3 cases of grade A,28 cases of grade B and 25 cases of grade C.In the endoscopic treatment group,the age ranged from 29 to 86 years,the median age was 57.5 years,and Child-Pugh liver function grading was 4 cases of grade A,40 cases of grade B and 49 cases of grade C.There was no significant difference in acute hemostasis rate between early TIPS group and Endoscopy Group(94.64%vs 92.47%).The rate of rebleeding in early TIPS group was lower than that in Endoscopy Group(0.00%vs 21.59%,3.84%vs 26.31%,8.69%vs 39.13%,7.31%vs 48.38%,19.44%vs 57.89%.28.00%vs 66.66%,P<0.05),and there was no significant difference between the two groups(33.33%vs 50.00%).The mortality rates of early TIPS group and endoscopy group were 8.92%and 6.45%respectively.The incidence of HE in early TIPS group was higher than that in Endoscopy Group(12.50%vs 0.00%,P=0.001)in the first month.There was no significant difference between the two groups in 3 months,6 months,1 year,2 years,3 years and 5 years(7.69%vs 1.75%,13.04%vs 4.34%,17.07%vs 3.22%,13.88%vs 0.001).The incidence of Child-Pugh A,Child-Pugh B,Child-Pugh C,Child-Pugh A,Child-Pugh A,Child-Pugh B,Child-Pugh C,Child-Pugh A,Child-Pugh B,Child-Pugh A,Child-Pugh A,Child-Pugh B and Child-Pugh C were 10.00%,16.67%and 83.33%respectively.[Conclusion]Early TIPS can effectively control acute EGVB;early TIPS can better prevent the occurrence of re-bleeding than endoscopic therapy;early TIPS can increase the incidence of HE in a short period of time than endoscopic therapy;early TIPS can slightly damage liver function in a short period of tiae without increasing medium-term and long-term damage;and early TIPS can be considered as the first-line treatment of acute EGVB in cirrhosis.