Combined Transjugular Intrahepatic Portosystemic Shunt Plus Variceal Obliteration versus Transjugular Intrahepatic Portosystemic Shunt Alone for the Management of Gastric Varices: Comparative Single-Center Clinical Outcomes.

Autor:	Shah KY; Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612. Electronic address: kyshah@uic.edu., Ren A; University of Illinois College of Medicine, Chicago, IL., Simpson RO; University of Illinois College of Medicine, Chicago, IL., Kloster ML; University of Illinois College of Medicine, Chicago, IL., Mikolajczyk A; Department of Medicine, University of Illinois Health, Chicago, IL., Bui JT; Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612., Lipnik AJ; Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612., Niemeyer MM; Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612., Ray CE; Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612., Gaba RC; Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612.
Jazyk:	angličtina
Zdroj:	Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2021 Feb; Vol. 32 (2), pp. 282-291.e1.
DOI:	10.1016/j.jvir.2020.10.009
Abstrakt:	Purpose: To compare the safety and clinical outcomes of combined transjugular intrahepatic portosystemic shunt (TIPS) plus variceal obliteration to those of TIPS alone for the treatment of gastric varices (GVs). Materials and Methods: A single-center, retrospective study of 40 patients with bleeding or high-risk GVs between 2008 and 2019 was performed. The patients were treated with combined therapy (n = 18) or TIPS alone (n = 22). There were no significant differences in age, sex, model for end-stage liver disease score, or GV type between the groups. The primary outcomes were the rates of GV eradication and rebleeding. The secondary outcomes included portal hypertensive complications and hepatic encephalopathy. Results: The mean follow-up period was 15.4 months for the combined therapy group and 22.9 months for the TIPS group (P = .32). After combined therapy, there was a higher rate of GV eradication (92% vs 47%, P = .01) and a trend toward a lower rate of GV rebleeding (0% vs 23%, P = .056). The estimated rebleeding rates were 0% versus 5% at 3 months, 0% versus 11% at 6 months, 0% versus 18% at 1 year, and 0% versus 38% at 2 years after combined therapy and TIPS, respectively (P = .077). There was no difference in ascites (13% vs 11%, P = .63), hepatic encephalopathy (47% vs 55%, P = .44), or esophageal variceal bleeding (0% vs 0%, P > .999) after the procedure between the groups. Conclusions: The GV eradication rate is significantly higher after combined therapy, with no associated increase in portal hypertensive complications. This translates to a clinically meaningful trend toward a reduction in GV rebleeding. The value of a combined treatment strategy should be prospectively studied in a larger cohort to determine the optimal management of GVs. (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu