Is TIPS really superior to endoscopic therapy in the prevention of rebleeding from gastric varices?

Abstract

We read with interest the paper by Lo et al. that compared transjugular intrahepatic portosystemic shunt (TIPS) with endoscopic cyanoacrylate injection for the prevention of rebleeding from gastric varices [1]. The authors randomized 72 patients with cirrhosis admitted to a single center for acute gastric variceal bleeding to receive either TIPS or repeated sessions of cyanoacrylate glue injection until obliteration of gastric varices was considered endoscopically to be complete. During the 36-month follow-up, they reported a higher rebleeding rate in the endoscopic treatment group than in the TIPS group (38 % vs. 11 %, P = 0.014), but no differences in survival or complications. As expected, episodes of hepatic encephalopathy were more frequent in patients from the TIPS group than in patients receiving endoscopic treatment [2]. The authors concluded that TIPS could be the treatment of choice to prevent rebleeding from gastric varices in patients with cirrhosis.