Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding
✍ Scribed by Alberto Monescillo; Francisco Martínez-Lagares; Luis Ruiz-Del-Arbol; Angel Sierra; Clemencia Guevara; Elena Jiménez; José Miguel Marrero; Enrique Buceta; Juan Sánchen; Ana Castellot; Mónica Peñate; Ana Cruz; Elena Peña
- Publisher
- John Wiley and Sons
- Year
- 2004
- Tongue
- English
- Weight
- 897 KB
- Volume
- 40
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Increased portal pressure during variceal bleeding may have an influence on the treatment failure rate, as well as on short-and long-term survival. However, the usefulness of hepatic hemodynamic measurement during the acute episode has not been prospectively validated, and no information exists about the outcome of hemodynamidy defined high-risk patients treated with early portal decompression. Hepatic venous pressure gradient (HVPG) measurement was made within the first 24 hours after admission of 116 consecutive patients with cirrhosis with acute v a r i d bleeding treated with a single session of sclerotherapy injection during urgent endoscopy. Sixty-four patients had an HVPG less than 20 mm Hg (low-risk [LR] group), and 52 patients had an HVPG greater than or equal to 20 mm Hg (high-risk [HR] group). HR patients were randomly allocated into those receiving transjugular intrahepatic portosystemic shunt (TIPS; HR-TIPS group, n = 26) within the first 24 hours after admission and those not receiving TIPS (HR-non-TIPS group). The HR-non-TIPS group had more treatment Mures (50% vs. 12%, P = .0001), transfusional requirements (3.7 & 2.7 vs. 2.2 f 2.3, P = .002), need for intensive care (16% vs. 3%, P < .05), and worse actuarial probability of survival than the LR group. Early TIPS placement reduced treatment failure (129' 0, P = .003), in-hospital and 1-year mortality (1 1% and 31%, respectively P < .05). In conclusion, increased portal pressure estimated by early HVPG measurement is a main determinant of treatment failure and survival in variceal bleeding, and early TIPS placement reduces treatment failure and mortality in high risk patients defined by hemodynamic criteria. (HEPATOLOGY 2004;40:793-801.) ariceal bleeding is a major complication of portal hypertension due to liver cirrhosis; it leads to a V high mortality (20%-30%), especially in those patients with treatment failure (TF; ie., no control of acute bleeding episode and/or early rebleeding). 1~