Left gastric vein embolization during TIPS placement for acute variceal bleeding has no effect on bleeding recurrence: Results of a multicenter study - 29/04/23
LVGE-TIPS Groupq
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Highlights |
• | In a multicenter retrospective study of 356 patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement for acute variceal bleeding, 21 (6%) patients experienced bleeding recurrence at six weeks. |
• | At six weeks, rebleeding-free survival does not differ significantly between patients who underwent left gastric vein embolization during TIPS placement (6/128; 5%) and those who did not (15/228; 7%) (P = 0.622). |
• | Multivariable analysis identifies persisting portal pressure gradient after transjugular intrahepatic portosystemic shunt placement as the single independent variable associated with bleeding recurrence. |
Abstract |
Purpose |
The purpose of this study was to evaluate whether concomitant left gastric vein embolization (LGVE) during transjugular intrahepatic portosystemic shunt (TIPS) for acute variceal hemorrhage could reduce the risk of bleeding recurrence.
Material and method |
A national multicenter observational study was conducted in 14 centers between January 2019 and December 2020. All cirrhotic patients who underwent TIPS placement for acute variceal bleeding were included. During TIPS procedure, size of left gastric vein (LGV), performance of LGVE, material used for LGVE and portosystemic pressure gradient (PPG) before and after TIPS placement were collected. A propensity score for the occurrence of LGVE was calculated to assess effect of LGVE on rebleeding recurrence at six weeks and one year.
Results |
A total of 356 patients were included (mean age 57.3 ± 10.8 [standard deviation] years; 283/356 [79%] men). Median follow-up was 11.2 months [interquartile range: 1.2, 13.3]. The main indication for TIPS was pre-emptive TIPS (162/356; 46%), rebleeding despite secondary prophylaxis (105/356; 29%), and salvage TIPS (89/356; 25%). Overall, 128/356 (36%) patients underwent LGVE during TIPS procedure. At six weeks and one year, rebleeding-free survival did not differ significantly between patients who underwent LGVE and those who did not (6/128 [5%] vs. 15/228 [7%] at six weeks, and 11/128 [5%] vs. 22/228 [7%] at one year, P = 0.622 and P = 0.889 respectively). A total of 55 pairs of patients were retained after propensity score matching. In patients without LGVE, the rebleeding rate was not different from those with LGVE (3/55 [5%] vs. 4/55 [7%], P > 0.99, and 5/55 [9%] vs. 6/55[11%], P > 0.99, at six weeks and one year respectively). Multivariable analysis identified PPG after TIPS placement as the only predictor of bleeding recurrence (hazard ratio = 1.09; 95% confidence interval: 1.02–1.18; P = 0.012).
Conclusion |
In this multicenter national real-life study, we did not observe any benefit of concomitant LGVE during TIPS placement for acute variceal bleeding on bleeding recurrence rate.
Le texte complet de cet article est disponible en PDF.Keywords : Esophageal and gastric varices, Gastrointestinal hemorrhage, Portal pressure, Portosystemic shunt, Propensity score, Transjugular intrahepatic portosystemic shunt
Abbreviations : AUC, CI, CT, HR, HBV, HCV, HVPG, IQR, LGV, LGVE, NASH, PPG, SD, SMD, TIPS
Plan
Vol 104 - N° 5
P. 248-257 - mai 2023 Retour au numéro
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