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Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage

  1. Luis García-Villarreal1,*,
  2. Francisco Martínez-Lagares2,
  3. Angel Sierra1,
  4. Clemencia Guevara1,
  5. José M. Marrero1,
  6. Elena Jiménez1,
  7. Alberto Monescillo1,
  8. Teresa Hernández-Cabrero2,
  9. José M. Alonso1,
  10. Rafael Fuentes3

Article first published online: 30 DEC 2003

DOI: 10.1002/hep.510290125

Issue

Hepatology

Hepatology

Volume 29, Issue 1, pages 27–32, January 1999

Additional Information

How to Cite

García-Villarreal, L., Martínez-Lagares, F., Sierra, A., Guevara, C., Marrero, J. M., Jiménez, E., Monescillo, A., Hernández-Cabrero, T., Alonso, J. M. and Fuentes, R. (1999), Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage. Hepatology, 29: 27–32. doi: 10.1002/hep.510290125

Author Information

  1. 1

    Service of Digestive Disorders, Hospital Insular Universitario, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

  2. 2

    Vascular and Interventional Radiology Unit, Hospital Insular Universitario, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

  3. 3

    Service of Radiology, Hospital Insular Universitario, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

*Servicio Digestivo, Hospital Insular Universitario, Plaza Dr Pasteur s/n, 35016 Las Palmas de Gran Canaria, Las Palmas, Spain. E-mail: fax: 34-28-444346

Publication History

  1. Issue published online: 30 DEC 2003
  2. Article first published online: 30 DEC 2003
  3. Manuscript Accepted: 4 AUG 1998
  4. Manuscript Received: 10 MAR 1998

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Abstract

Variceal hemorrhage continues to be a major cause of morbidity and mortality in cirrhotic patients. Transjugular intrahepatic portosystemic shunt (TIPS) is gaining wide acceptance as a treatment for several complications of portal hypertension. The aim of the current randomized study was to compare the transjugular shunt and endoscopic sclerotherapy (ES) for the prevention of variceal rebleeding (VB) in cirrhotic patients. Forty-six consecutive cirrhotic patients with variceal bleeding were randomly allocated to receive either transjugular shunt (22 patients) or ES (24 patients) 24 hours after control of bleeding. VB (50% vs. 9%) and early (first 6 weeks) VB (33% vs. 5%) were significantly more frequent in sclerotherapy patients; the actuarial probability of being free of VB was higher in the shunt group (P < .002). Eight patients (33%) of the sclerotherapy group and 3 patients (15%) of the shunt group died; the actuarial probability of survival was higher for the shunted patients (P < .05); 6 patients in the sclerotherapy group and none in the shunt group died from VB (P < .05). No difference was found in the proportion of patients with clinically evident hepatic encephalopathy (HE). These results show that the transjugular shunt is more effective than sclerotherapy in the prevention of both early and long-term VB. Moreover, a significant improvement in survival was found in the shunt group.

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