Clinical Trials Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 18, 2016; 8(20): 850-857
Published online Jul 18, 2016. doi: 10.4254/wjh.v8.i20.850
Transjugular intrahepatic portosystemic shunt combined with esophagogastric variceal embolization in the treatment of a large gastrorenal shunt
Qin Jiang, Ming-Quan Wang, Guo-Bing Zhang, Qiong Wu, Jian-Ming Xu, De-Run Kong
Qin Jiang, Department of Gastroenterology, 161 Hospital of Chinese People’s Liberation Army, Wuhan 430000, Hubei Province, China
Qin Jiang, Qiong Wu, Jian-Ming Xu, De-Run Kong, Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Ming-Quan Wang, Guo-Bing Zhang, Department of Intervention, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Author contributions: Jiang Q was involved in analysis and interpretation of data, as well as drafting the manuscript; Jiang Q and Kong DR designed the research; Jiang Q and Wu Q performed the research; Wang MQ, Zhang GB, and Xu JM provided TIPS technical support and were involved in study supervision; Xu JM and Kong DR were involved in study design, analysis and interpretation of data, critical revision of the manuscript, and study supervision.
Supported by National Natural Science Foundation of China, Nos. 81070337 and 81271736.
Institutional review board statement: The study was approved by the Ethics Committee of Anhui Medical University.
Informed consent statement: All involved patients gave their informed written consent prior to study inclusion.
Conflict-of-interest statement: We declare that we have no financial or personal relationships with other individuals or organizations that can inappropriately influence our work. We have no professional or personal interests of any nature related to any product, service, and/or company that could be construed as influencing the position presented within, or the review of, the entitled manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at kdr168@sohu.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: De-Run Kong, MD, Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, Anhui Province, China. kdr168@sohu.com
Telephone: +86-551-62922039 Fax: +86-551-65120742
Received: March 27, 2016
Peer-review started: March 28, 2016
First decision: April 19, 2016
Revised: May 5, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: July 18, 2016
Processing time: 107 Days and 15.7 Hours
Abstract

AIM: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with stomach and esophageal variceal embolization (SEVE) in cirrhotic patients with a large gastrorenal vessel shunt (GRVS).

METHODS: Eighty-one cirrhotic patients with gastric variceal bleeding (GVB) associated with a GRVS were enrolled in the study and accepted TIPS combined with SEVE (TIPS + SEVE), by which portosystemic pressure gradient (PPG), biochemical, TIPS-related complications, shunt dysfunction, rebleeding, and death were evaluated.

RESULTS: The PPGs before TIPS were greater than 12 mmHg in 81 patients. TIPS + SEVE treatment caused a significant decrease in PPG (from 37.97 ± 6.36 mmHg to 28.15 ± 6.52 mmHg, t = 19.22, P < 0.001). The percentage of reduction in PPG was greater than 20% from baseline. There were no significant differences in albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time, or Child-Pugh score before and after operation. In all patients, rebleeding rates were 3%, 6%, 12%, 18%, and 18% at 1, 3, 6, 12, and 18 mo, respectively. Five patients (6.2%) were diagnosed as having hepatic encephalopathy. The rates of shunt dysfunction were 0%, 4%, 9%, 26%, and 26%, at 1, 3, 6, 12, and 18 mo, respectively. The cumulative survival rates in 1, 3, 6, 12, and 18 mo were 100%, 100%, 95%, 90%, and 90%, respectively.

CONCLUSION: Our preliminary results indicated that the efficacy and safety of TIPS + SEVE were satisfactory in cirrhotic patients with GVB associated with a GRVS (GVB + GRVS).

Keywords: Transjugular intrahepatic portosystemic shunt; Cirrhosis; Gastric varices; Variceal embolization; Gastrorenal shunt

Core tip: The optimal treatment of gastric variceal bleeding (GVB) + gastrorenal vessel shunt (GRVS) remains uncertain. Transjugular intrahepatic portosystemic shunt (TIPS) alone cannot be widely used in the treatment of GVB + GRVS. Some studies have evaluated the short-term outcomes of cirrhosis treated with TIPS combined with variceal embolization. In this study, we found that the efficacy and safety of TIPS + stomach and esophageal variceal embolization were satisfactory for patients with GVB + GRVS.