Clinical outcome comparison between TIPS and EBL in patients with cirrhosis and portal vein thrombosis.

Abstract

The aim of this study is to compare the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic band ligation (EBL) in patients with cirrhosis and portal vein thrombosis (PVT). We retrospectively reviewed the January to September 2010 data from our database and included 25 patients with cirrhosis and PVT who underwent successful TIPS creation. We selected another 25 patients who underwent EBL matching for age, sex, and Child-Pugh-Turcotte class. The outcome measures included changes in the PVT status before and after the treatments, the rebleeding rate, and the overall survival. The mean follow-up was 25.1 ± 8.7 months in the EBL group and 25.6 ± 8.5 months in the TIPS group (P = 0.85). After treatments, the PVT severity improved in 40% and worsened in 25% of patients who did not undergo TIPS, compared with 87% and none of the patients who underwent TIPS (P < 0.001). Previous splenectomy (OR 0.13, 95% CI 0.02-0.76, P = 0.024) and patency status of TIPS (OR 20.8, 95% CI 3.0-141.8, P = 0.002) were the independent factors associated with PVT disappearance. The 1- and 2-year rebleeding rates were, respectively, 44.6% and 59.0% in the EBL group, and 12.5% and 25.2% in the TIPS group (P = 0.002). The 1- and 2-year survival rates were, respectively, 95.7% and 85.2% in the EBL group, and 96% and 78.7% in the TIPS group (P = 0.203). The MELD score was the only independent predictive factor for survival (HR 1.73, 95% CI 1.27-2.37, P = 0.001). Compared with EBL, TIPS contributed to PVT improvement and reduced the risk of rebleeding without providing a survival benefit for patients with PVT.