Hu XG, Dai JJ, Lu J, Li G, Wang JM, Deng Y, Feng R, Lu KP. Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding. World J Gastrointest Surg 2024; 16(2): 471-480 [PMID: 38463371 DOI: 10.4240/wjgs.v16.i2.471]
Corresponding Author of This Article
Kai-Ping Lu, MM, Associate Chief Physician, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou 310000, Zhejiang Province, China. lukaiping158@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Feb 27, 2024; 16(2): 471-480 Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.471
Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding
Xiao-Gang Hu, Jian-Ji Dai, Jun Lu, Gang Li, Jia-Min Wang, Yi Deng, Rui Feng, Kai-Ping Lu
Xiao-Gang Hu, Jian-Ji Dai, Jun Lu, Gang Li, Jia-Min Wang, Yi Deng, Department of Interventional Radiology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
Rui Feng, Department of Interventional Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Kai-Ping Lu, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Author contributions: Hu XG and Lu KP designed the study; Hu XG and Dai JJ wrote the manuscript; Hu XG, Lu J, Li G, Deng Y, and Wang JM performed the experiments; Hu XG, Dai JJ and Feng R analyzed the data; Lu KP revised and reviewed the manuscript; and all the authors read and approved the final manuscript.
Institutional review board statement: The study was approved by Ethics Committee of Affiliated Jinhua Hospital, Zhejiang University School of Medicine.
Informed consent statement: The data used in the study were not involved in the patients’ privacy information, and all patient data obtained, recorded, and managed only used for this study, without any harm to the patient. So the informed consent was waived by the Ethics Committee of Affiliated Jinhua Hospital, Zhejiang University School of Medicine.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai-Ping Lu, MM, Associate Chief Physician, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou 310000, Zhejiang Province, China. lukaiping158@126.com
Received: November 22, 2023 Peer-review started: November 22, 2023 First decision: December 8, 2023 Revised: December 15, 2023 Accepted: January 9, 2024 Article in press: January 9, 2024 Published online: February 27, 2024 Processing time: 95 Days and 6.3 Hours
Abstract
BACKGROUND
Esophageal-gastric variceal bleeding (EGVB) represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes. Interventional therapy, a rapidly developing treatment modality over the past few years, has found widespread application in clinical practice due to its minimally invasive characteristics. However, whether transjugular intrahepatic portosystemic shunt (TIPS) treatment has an impact on patient prognosis remains controversial.
AIM
To probing the efficacy of TIPS for treating cirrhotic EGVB and its influence on the prognosis of patients afflicted by this disease.
METHODS
A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022. Based on the different modes of treatment, the patients were assigned to the study group (TIPS received, n = 50) or the control group (percutaneous transhepatic varices embolization received, n = 42). Comparative analyses were performed between the two groups preoperatively and one month postoperatively for the following parameters: Varicosity status; hemodynamic parameters [portal vein flow velocity (PVV) and portal vein diameter (PVD); platelet count (PLT); red blood cell count; white blood cell count (WBC); and hepatic function [albumin (ALB), total bilirubin (TBIL), and aspartate transaminase (AST)]. The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups, and the 1-year postoperative rebleeding and survival rates were compared.
RESULTS
Following surgical intervention, there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts. Notably, the study group exhibited more pronounced enhancements than did the control group (P < 0.05). PVV increased, and PVD decreased compared to the preoperative values, with the study cohort achieving better outcomes (P < 0.05). PLT and WBC counts were elevated postoperatively in the two groups, with the study cohort displaying higher PLT and WBC counts (P < 0.05). No differences were detected between the two groups in terms of serum ALB, TBIL, or AST levels either preoperatively or postoperatively (P < 0.05). Postoperative scores across all dimensions of life quality surpassed preoperative scores, with the study cohort achieving higher scores (P < 0.05). At 22.00%, the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group (42.86%; P < 0.05); conversely, no marked difference was observed in the 1-year postoperative survival rate between the two cohorts (P > 0.05).
CONCLUSION
TIPS, which has demonstrated robust efficacy in managing cirrhotic EGVB, remarkably alleviates varicosity and improves hemodynamics in patients. This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.
Core Tip: Esophageal-gastric variceal bleeding (EGVB) is a severe and life-threatening complication associated with cirrhosis. The implementation of transjugular intrahepatic portosystemic shunt (TIPS) has emerged as an effective strategy for both the treatment and prophylaxis of EGVB. The objective of this study was to evaluate the effectiveness of TIPS in terms of cirrhosis-triggered EGVB treatment and to probe its impact on patient prognosis. The research outcomes contribute valuable insights into the management of acute variceal bleeding and the enhancement of long-term prognostic outcomes for individuals with advanced hepatopathy. A comprehensive understanding of the benefits and potential risks associated with TIPS is pivotal for the development of personalized strategies for the treatment of variceal bleeding attributed to cirrhosis.
