9:20 AM Abstract No. 127 - Clinical outcomes of BRTO only versus BRTO and TIPS for the management of gastric variceal bleeding: A multi center USA study

Abstract

<h3>Purpose</h3> To assess the synergistic effect (benefit), if any, of combining TIPS and BRTO for the management of gastric variceal (GV) bleeding. The hypothesis being that TIPS compensates for the closure of the gastrorenal shunt (a spontaneous portosystemic shunt) during the BRTO procedure. <h3>Materials and Methods</h3> A retrospective audit of patients undergoing BRTO for the management of GV bleeding was performed (2007-2012) in 8 centers in the United States. The cohort was divided into patients that underwent BRTO only and those that underwent BRTO with coexisting TIPS (BRTO+TIPS group). The BRTO+TIPS group was subdivided to concomitant TIPS (TIPS created within 2 weeks from the BRTO) and prior TIPS (>2 weeks prior to the BRTO). Demographic comparisons were made between the groups. Kaplan-Meier method was used for rebleed and survival rates (comparisons were by Log-Rank test). <h3>Results</h3> 100 patients underwent BRTO only and 18 patients underwent BRTO with a coexisting TIPS. The technical and GV obliterative rate for BRTO+TIPS compared to BRTO only was 100% (n=18/18) and 100% (n=18/18) compared to 91% (n=94/103) and 80% (n=80/100), respectively (p=0.039). The complication rate and 30-day mortality for BRTO+TIPS compared to BRTO only was 6% (n=1/18) and 11% (n=2/18) compared to 2% (n=2/103) and 5% (n=5/100), respectively (p=0.3 to 0.4). The long-term outcomes of successful procedures are shown in the table. <h3>Conclusion</h3> Despite the trend of reduced rebleeding and the occurrence clinically significant ascites in patients undergoing BRTO with coexisting TIPS compared with BRTO-only, TIPS adds no significant value to the BRTO procedure. Patients with prior TIPS have a better survival than patients who undergo a combined BRTO and TIPS procedure. Table 1