Early TIPS Beneficial in Acute Esophageal Variceal Bleeding
In-hospital reductions in rebleeding, mortality with transjugular intrahepatic portosystemic shunt
MONDAY, Sept. 26, 2016 (HealthDay News) -- For patients presenting with acute esophageal variceal bleeding (EVB), early transjugular intrahepatic portosystemic shunt (TIPS) is associated with reductions in in-hospital rebleeding and mortality, with no increase in hepatic encephalopathy, according to a study published online Sept. 14 in the Journal of Gastroenterology and Hepatology.
Basile Njei, M.D., M.P.H., from the Yale University School of Medicine in New Haven, Conn., and colleagues examined the impact of early TIPS on outcomes for U.S. patients hospitalized with EVB from 2000 and 2010. Data were included for 142,539 patients with EVB and decompensated cirrhosis.
The researchers observed a decrease in the age-adjusted in-hospital mortality rate from 656 to 412 per 100,000 (37.2 percent decrease; P < 0.01), while early and rescue TIPS increased (0.22 to 0.70 percent [P < 0.01] and 1.1 to 6.1 percent [P < 0.01], respectively). In multivariate analysis, early TIPS correlated with decreased inpatient mortality (risk ratio [RR], 0.87; 95 percent confidence interval [CI], 0.84 to 0.90) and rebleeding (RR, 0.56; 95 percent CI, 0.45 to 0.71) compared with no TIPS; there was no increase in hepatic encephalopathy (RR, 1.01; 95 percent CI, 0.93 to 1.11).
"Early preventive TIPS in patients with EVB and decompensated cirrhosis was associated with significant in-hospital reductions in rebleeding and mortality without a significant increase in encephalopathy in 'real-world' U.S. clinical practice," the authors write.