3:54 PMAbstract No. 387 - Persistence of varices on CT or MR imaging and risk of variceal hemorrhage after transjugular intrahepatic portosystemic shunt with embolotherapy

Abstract

To determine whether the presence of visible varices on contrast-enhanced CT or MR imaging after TIPS with adjunctive procedures to occlude varices predicts future variceal bleeding. In this single-center, retrospective study, 121 patients underwent TIPS creation for variceal hemorrhage or ascites using ePTFE-covered stents with adjunctive variceal occlusion from Jan 2005 to Jun 2015. Patients without post-TIPS contrast-enhanced CT or MR imaging were excluded (n = 59). Patient demographics and post-TIPS outcomes were recorded, while visualization of varices ≥2mm on cross-sectional imaging was confirmed by two independent radiologists. ANOVA, Chi-squared, and Fisher’s exact tests were used to assess continuous and categorical data. 24 patients (38.7%) had persistent visible varices (VIS) on follow-up cross-sectional imaging, while 38 patients (61.3%) no longer had visible varices (NON-VIS). Except for age (57.5 yrs vs 50.9 yrs, p = 0.032), preoperative characteristics did not differ between VIS and NON-VIS groups, and mean time to follow-up imaging (VIS 183 days vs NON-VIS 215 days, p = 0.719) was similar. Variceal occlusion method (embolization vs embolization plus sclerotherapy) did not significantly affect the proportion of patients with visible varices (embolization 47.6% vs embolization plus sclerotherapy 36.6%, p = 0.654). In patients with persistent varices, 22 (91.7%) showed esophageal varices, of which 17 (77.3%) protruded intraluminally, while 15 (62.5%) had gastric varices, of which 6 (40%) protruded intraluminally. Mean size of esophageal vs gastric varices did not significantly differ (5.3 mm vs 6.1 mm, p = 0.381). The presence of visible varices did not increase the rate of rebleeding (VIS 0.0%, vs NON-VIS 7.9%, p = 0.16) or rate of repeat variceal occlusion interventions (VIS 0.0% vs NON-VIS 7.9%, p = 0.16). Despite procedures to occlude varices, 38.7% of patients had persistent variceal filling on cross-sectional imaging. The presence of visibly filling varices on cross-sectional imaging after TIPS with embolotherapy did not confer a higher risk for rebleeding. The study is limited by few rebleeding events.