Transjugular Intrahepatic Portosystemic Shunt improves rebleeding and survival in gastric variceal hemorrhage

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Background and objective Variceal hemorrhage (VH) is a life-threatening complication of liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) is so far the most efficient treatment for preventing rebleeding. TIPS also improves survival in selected patients populations with VH. However, the majority of studies conducted so far have focused on esophageal VH. The aim of this study is the assessment of the efficacy of TIPS in gastric VH. Methods This study is a multicenter retrospective analysis of prospective data, including 429 patients with liver cirrhosis and VH. Our primary outcome was six-month mortality. The secondary outcome was occurrence of rebleeding within six months. Results The median age was 58 years, most patients were males (72%). 105 patients presented with gastric variceal hemorrhage (VH), of which 23 were treated with TIPS. 324 patients presented with esophageal VH, of which 72 were treated with TIPS. In gastric VH, TIPS treatment significantly improved 6-month survival (4.3 vs. 24.4%, p=0.034) and rebleeding rates (4.3 vs. 23.2%, p=0.042) compared to standard of care (SOC). Similary, TIPS treatment significantly improved 6-month survival (18.1 vs. 29.8%, p=0.049) and rebleeding rates (17.9% vs. 6.9%, p=0.024) in esophageal VH as well. Conclusion Secondary prophylaxis with TIPS significantly reduces the risk of rebleeding and improves six-month survival rates in both gastric and esophageal variceal hemorrhage (VH). Publication History Article published online: 23 January 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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