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TIPS superior to endoscopic therapy for variceal bleeding in cirrhosis

Transjugular intrahepatic portosystemic shunt placement was more safe and effective against variceal rebleeding in patients with cirrhosis, compared with endoscopic therapy plus beta-blocker.

“In this multicenter, randomized, controlled trial, we showed that [transjugular intrahepatic portosystemic shunt] placement is superior to [endoscopic variceal ligation plus beta-blocker] treatment for secondary prevention of variceal bleeding, but this does not translate into improved survival,” the researchers wrote.

To compare the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with endoscopic therapy plus beta-blocker, researchers randomly assigned 72 patients with cirrhosis to one of the procedures after a median of 4 days from index bleeding. Each patient experienced a first or second episode of gastric and/or esophageal variceal bleeding, after hemodynamic stabilization upon endoscopic, vasoactive and antibiotic treatment. Thirty-five patients received endoscopic therapy plus a beta-blocker and 37 received TIPS. The primary outcome of the study was significant variceal rebleeding, according to the research.

Over a median follow-up of 23 months, 29% of patients in the endoscopy group developed variceal rebleeding (n = 10) compared with 0% of patients in the TIPS group (P = .001).

Mortality rate was higher among patients who received TIPS compared with endoscopy (32% vs. endoscopy: 26%; P = .418), as well as treatment failure (TIPS: 38% vs. endoscopy: 34%; P = .685). However, these were not significantly different between the groups.

The development of hepatic encephalopathy within 1 year was more frequent in the TIPS group (35%) compared with the endoscopy plus beta-blocker group (14%; P = .035), but the gap in frequency closed over long-term follow-up (38% vs. 23%; P = .121).

The researchers concluded: “Additional results of studies on cost-effectiveness, quality of life and randomization between early and elective TIPS placement will contribute to further define the optimal treatment regimen for patients presenting with [gastroesophageal variceal bleeding].” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.