Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1871
Peer-review started: February 4, 2020
First decision: March 18, 2020
Revised: March 28, 2020
Accepted: April 15, 2020
Article in press: April 15, 2020
Published online: May 26, 2020
Processing time: 111 Days and 8.2 Hours
Different treatment strategies for recurrent gastroesophageal variceal bleeding in patients with liver cirrhosis include transjugular intrahepatic portosystemic shunt (TIPS), splenectomy plus esophagogastric devascularization (SED) and endoscopic therapy + non-selective β-blockers (ET + NSBB). These three treatments have not been compared in idiopathic non-cirrhotic portal hypertension (INCPH).
The motivation of this study was to provide suggestions for clinical practitioners when treating patients with INCPH.
This study compared the outcomes of TIPS, SED and ET + NSBB in the control of variceal rebleeding in patients with INCPH.
This study retrospectively recruited patients from six centers across China. Clinical data and outcomes were collected. Complications including incidence of rebleeding, hepatic encephalopathy (HE), portal vein thrombosis (PVT) and mortality rates were compared in different groups.
Eight-one patients were recruited, with twenty-eight receiving TIPS, twenty-six SED and twenty-seven ET + NSBB. Rebleeding rate was significantly higher in the ET + NSBB group (P < 0.01). Mortality was 3.6%, 3.8% and 14.8% in the TIPS, SED and ET + NSBB groups, respectively, and the differences were not significantly different (P = 0.082). Logistic regression analysis showed that mortality was significantly correlated with rebleeding, HE, portal thrombosis and superior mesenteric vein thrombosis (P < 0.05).
In patients with INCPH, TIPS and SED were more effective in controlling rebleeding than ET + NSBB, but survival rates were not significantly different among the three groups. Mortality was significantly correlated with rebleeding, HE and PVT.
This study showed that TIPS and SED were more suitable in controlling rebleeding in patients with INCPH. In the future, more patients should be included and the follow-up period should be prolonged to examine further the long-term results.