TIPS increases quality of life after 1 year vs. endoscopy and beta-blocker

SAN DIEGO — Patients with cirrhosis had improved quality of life one year after treatment with transjugular intrahepatic portosystemic shunt placement compared with endoscopic therapy plus beta-blocker, for the secondary prevention of gastroesophageal variceal bleeding, according to a study presented at DDW 2016.

“Gastroesophageal variceal bleeding, or GEVB, is a severe complication of portal hypertension. In these patients, there is a high chance of rebleeding associated with significant morbidity and mortality. … TIPS placement forms an alternative, but is only recommended for patients who fail endoscopic and pharmacological therapy and only recommended in patients with high risk of treatment failures,” Jihan Harki, MD, department of gastroenterology and hepatology, Erasmus MC University Medical Center Rotterdam, the Netherlands, said during her presentation.

To compare the health-related quality of life (HRQoL) in patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) with HRQoL in patients who underwent endoscopic therapy plus beta-blocker, Harki and colleagues evaluated data of 72 patients with cirrhosis who participated in a randomized controlled clinical trial and survived a first or second episode of gastroesophageal bleeding. The researchers used EUROQOL-5D before patients were randomized in the trials and then through 1 year of therapy to measure HRQoL, with a primary endpoint of changes in HRQoL after 1 year of treatment.

Harki said HRQoL is unknown for the treatments, but acknowledge that both have their downsides.

“EVL requires multiple sessions and is associated with high rebleedings and ulcers,” Harki said during her presentation. “On the other hand, TIPS is an expensive procedure that carries risk of severe complications, such as liver bleeding, injury or heart failure and carries high risk of hepatic encephalopathy. However, the health-related quality of life is unknown [for both].”

The final analysis included 63 patients of who 34 underwent TIPS and 29 received endoscopic variceal ligation plus propranolol.

“What we found was the mean quality of life of all included patients was 0.74 and was significantly lower than that of the general Dutch population,” Harki said.

At baseline, patients who received endoscopic variceal ligation plus propranolol had better HRQoL (0.78) compared with patients who underwent TIPS (0.70; P = .19). However, Harki said that this was not significant and after 1 year, the HRQoL of 22 patients who received TIPS had higher HRQoL (0.85) compared with patients who received endoscopic variceal ligation plus propranolol (0.69; P = .047).

Among the entire cohort, the HRQoL was higher in patients with early cirrhosis (Child-Pugh A: 0.83) compared with patients with advanced cirrhosis (Child-Pugh B: 0.7 vs. Child-Pugh C: 0.59), at baseline.

Harki concluded: “We found that patients treated with TIPS for the secondary prevention of gastroesophageal variceal bleeding reported a significant increase in quality of life after 12 months follow-up and they had higher quality of life after 12 months compared to patients treated with endoscopic therapy. … I think this is clinically relevant since we found significant results, however larger studies are needed with more patients and it would be very interesting to put more focus on cost effectiveness of both treatment strategies in this patient group.” – by Melinda Stevens

Reference:

Harki J, et al. Abstract #229. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosure: Please see the DDW disclosure list for any relevant financial disclosures.