Early use of TIPS in patients with cirrhosis and variceal bleeding

Abstract

ACP Journal Club16 November 2010Early use of TIPS in patients with cirrhosis and variceal bleedingJuan Carlos Garcia-Pagán, MD, Jaime Bosch, MDJuan Carlos Garcia-Pagán, MDHepatic Hemodynamic Laboratory. Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.C.G., J.B.)Search for more papers by this author, Jaime Bosch, MDHepatic Hemodynamic Laboratory. Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.C.G., J.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-10-201011160-02013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To the EditorWe disagree with several points in the commentary of our study on early use of transjugular intrahepatic portosystemic shunts (TIPS) in patients with cirrhosis and variceal bleeding (1), which was abstracted in ACP Journal Club (2). TIPS should be offered as a first treatment option only to a small proportion of patients with acute variceal hemorrhage—that is, those at high risk for treatment failure. Our study clearly shows that in this high-risk cirrhotic population, mortality is reduced with early use of TIPS. Therefore, to exclude 82% of patients is not a limitation of the study, as suggested by ...References1 García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370-9. [PMID: 20573925] Google Scholar2 Korula J. ACP Journal Club: Early use of transjugular intrahepatic portosystemic shunts improved outcomes in patients with cirrhosis and variceal bleeding. Ann Intern Med. 2010:153(4):JC4-6. Comment on: García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370-9. Google Scholar3 de Franchis R, on behalf of the Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010; 53:762-8. [PMID: 20638742] Google Scholar4 Gonzalez R, Zamora J, Gomez-Camarero J, et al. Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Ann Intern Med. 2008;149:109-22. [PMID: 18626050] Google Scholar5 García-Pagán JC, Villanueva C, Albillos A, et al; Spanish Variceal Bleeding Study Group. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: a multicentre randomized controlled trial. Gut. 2009;58:1144-50. [PMID: 19218249] Google Scholar6 Kumar A, Jha SK, Sharma P, et al. Addition of propranolol and isosorbide mononitrate to endoscopic variceal ligation does not reduce variceal rebleeding incidence. Gastroenterology. 2009;137:892-901. [PMID: 19481079] Google Scholar7 Laine L, el-Newihi HM, Migikovsky B, Sloane R, Garcia F. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann Intern Med. 1993;119:1-7. [PMID: 8498757] Google Scholar Author, Article, and Disclosure InformationAuthors: Juan Carlos Garcia-Pagán, MD; Jaime Bosch, MDAffiliations: Hepatic Hemodynamic Laboratory. Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.C.G., J.B.)This article was published at Annals.org on 2 November 2010. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMCM7 silencing promotes cutaneous melanoma cell autophagy and apoptosis by inactivating the AKT1/mTOR signaling pathwayDifferent scoring systems to predict 6-week mortality in cirrhosis patients with acute variceal bleeding: a retrospective analysis of 202 patientsIntensive Care Therapy for Patients with Advanced Liver DiseasesCombination therapy versus pharmacotherapy, endoscopic variceal ligation, or the transjugular intrahepatic portosystemic shunt alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized controlled trials 16 November 2010Volume 153, Issue 10Page: JC5-13KeywordsCirrhosisDeath ratesDrug therapyDrugsHemorrhageLigation assayLiverMorbidityMortalityNitrates ePublished: 16 November 2010 Issue Published: 16 November 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...