Emergency transjugular intrahepatic portasystemic stent shunts to control acute variceal hemorrhage resistant to sclerotherapy

Kenneth J. Simpson, Nicholas Chalmers, Doris N. Redhead, John F. Dillon, Niall D.C. Finlayson, Peter C. Hayes

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Objective: To prospectively assess the efficacy and outcome of emergency transjugular intrahepatic portasystemic stent shunts (TIPSS) in patients with acute variceal haemorrhage resistant to sclerotherapy. Design: Patients in whom active variceal haemorrhage was observed at endoscopy were treated initially with sclerotherapy. If this failed to control bleeding, emergency TIPSS were undertaken. Patients: Thirteen patients underwent emergency TIPSS during an 18-month period. Main outcome measures: Survival, re-bleeding, disturbance of liver function and the occurrence of post-TIPSS encephalopathy. Results: TIPSS were successfully performed in 11 out of 13 patients. The two patients in whom TIPSS were unsuccessful died, one patient died from a procedure-related complication and three patients with functioning shunts died within 1 week from severe liver failure. The eight surviving patients are alive and well between 2 and 1 7 months post-TIPSS; one has had a successful liver transplant. Only two episodes of re-bleeding occurred, both during the first week post-TIPSS, due to an inadequate shunt in one patient and from sclerotherapy ulcers in the other. One patient developed clinically apparent encephalopathy following TIPSS. Conclusions: TIPSS are a valid therapeutic option in patients with acute variceal haemorrhage in whom variceal sclerotherapy has failed. Prevention of re-bleeding is noted in the long-term survivors. However, severe liver failure with a fatal outcome following successful TIPSS occurred in 27% of these severely ill patients.
Original languageEnglish
Pages (from-to)423-428
Number of pages6
JournalEuropean Journal of Gastroenterology & Hepatology
Volume6
Issue number5
Publication statusPublished - 1 Jan 1994

Keywords

  • Cirrhosis, portal hypertension
  • Transjugular intrahepatic portasystemic stent shunt
  • Variceal haemorrhage

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