Abstract No. 655 Treatment of peristomal hemorrhage: a review of outcomes and comparison of two minimally invasive techniques

Abstract

Development of peristomal variceal bleeding in patients who undergo ostomy formation and have or develop portal hypertension is common. While many different minimally invasive techniques have been described the data is sparse and no direct comparison between techniques has been made. This article aims to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments. After IRB approval 5 patients who underwent 9 sclerotherapy treatments and 7 patients who underwent TIPS placement for peristomal variceal bleeding were retrospectively reviewed. Data pertaining to the technical aspects of the procedure, demographics, and information regarding the underlying cause of ostomy and portal hypertension were collected. Treatment was considered a primary success if no further hemorrhage occurred. Sclerotherapy patients trended toward having a poorer nutritional status (albumin mean 2.04 and 2.95 g/dL in sclerotherapy and TIPS groups respectively p = 0.04) and worse liver function (total bilirubin 4.9 and 1.6 mg/dL in the sclerotherapy and TIPS group respectively p = 0.07). Primary success was statistically better in the TIPS cohort (100%) versus the sclerotherapy cohort (40%) (p = 0.04). One patient died of recurrent massive peristomal hemorrhage 6 months after initial sclerotherapy, and one patient required admission for hepatic encephalopathy following TIPS. There was no statistically significant difference in complications following TIPS and sclerotherapy (p = 1). TIPS appears to be more effective than sclerotherapy in treating peristomal variceal bleeding. However, sclerotherapy may be an effective bridging technique for patients who have acute decompensation of liver function.