Abstract
Background Transjugular intrahepatic portosystemic shunt (TIPS) is suggested as the salvage therapy for gastroesophageal variceal bleeding in cirrhosis. However, rebleeding might occur in some patients after TIPS. Currently, there is a lack of evidence in the endoscopic management of recurrent bleeding in these patients. Aims To evaluate the efficacy of endoscopic treatment in cirrhotic patients with recurrent bleeding after TIPS. Methods Cirrhotic patients with gastroesophageal varices who received endoscopic treatment for recurrent bleeding after TIPS were included. Results 6 patients were enrolled in this study. The median age of the patients was 47 years (range 27 to 65 years), and the duration of follow-up time was 346 (17-773) days. Stent stenosis or occlusion was found in 5 out of 6 patients after TIPS. Salvage endoscopic treatment, including esophageal variceal ligation (EVL), gastric variceal cyanoacrylate injection, esophageal variceal sclerotherapy, and balloon-occluded retrograde transvenous obliteration- (BRTO-) assisted endoscopic cyanoacrylate injection. Among included patients, 2 died shortly after EVL (14 and 19 days) due to variceal bleeding. Among other 4 patients, 2 had rebleeding episodes at 422 and 789 days, respectively. Conclusion Endoscopic treatment may be an option for recurrent bleeding after TIPS in selected patients. Further studies are needed to carefully define the indication and efficacy of this option.
Highlights
Portal hypertension (PHT) is a clinical syndrome mostly caused by liver cirrhosis
Among patients admitted to Zhongshan Hospital between January 2017 and August 2019 who received endoscopic treatments such as secondary prophylaxis for variceal bleeding, 76 patients received both endotherapies and Transjugular intrahepatic portosystemic shunt (TIPS)
The patient who received balloon-occluded retrograde transvenous obliteration- (BRTO-)assisted endoscopic cyanoacrylate injection had been previously treated with esophageal variceal sclerotherapy (EVS) twice after TIPS at another hospital; these treatments failed to prevent rebleeding
Summary
Portal hypertension (PHT) is a clinical syndrome mostly caused by liver cirrhosis. Other etiologies, such as isolated portal vein thrombosis and Budd-Chiari syndrome, account for less than 10% of the cases [1]. Current guidelines suggest that nonselective beta-blockers (NSBBs) plus endoscopic variceal ligation (EVL) are a standard therapy for secondary prophylaxis of variceal rebleeding [3]. Transjugular intrahepatic portosystemic shunt (TIPS) is recommended as the rescue therapy after the failure of combined medical and endoscopic therapies for prophylaxis of variceal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) is suggested as the salvage therapy for gastroesophageal variceal bleeding in cirrhosis. There is a lack of evidence in the endoscopic management of recurrent bleeding in these patients. To evaluate the efficacy of endoscopic treatment in cirrhotic patients with recurrent bleeding after TIPS. Cirrhotic patients with gastroesophageal varices who received endoscopic treatment for recurrent bleeding after TIPS were included. 2 died shortly after EVL (14 and 19 days) due to variceal bleeding. Endoscopic treatment may be an option for recurrent bleeding after TIPS in selected patients. Further studies are needed to carefully define the indication and efficacy of this option
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