Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts
Article first published online: 17 APR 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 28, Issue 3, pages 294–303, August 2008
How to Cite
KOCHAR, N., TRIPATHI, D., MCAVOY, N. C., IRELAND, H., REDHEAD, D. N. and HAYES, P. C. (2008), Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts. Alimentary Pharmacology & Therapeutics, 28: 294–303. doi: 10.1111/j.1365-2036.2008.03719.x
- Issue published online: 4 JUL 2008
- Article first published online: 17 APR 2008
- Publication data Submitted 29 September 2007 First decision 14 October 2007 Resubmitted 29 March 2008 Accepted 14 April 2008 Epub OnlineAccepted 17 April 2008
Aliment Pharmacol Ther 28, 294–303
Background Bleeding from ectopic varices is uncommon but can be difficult to manage.
Aim To report our experience of the use of transjugular intrahepatic portosystemic stent shunts (TIPSS) in the management of uncontrolled bleeding from ectopic varices.
Methods A retrospective study of patients who had TIPSS for bleeding ectopic varices. Patients were selected from a dedicated data base.
Results Over 14 years, of 750 TIPSS insertions, 28 patients had TIPSS for bleeding ectopic varices (Child–Pugh score: 8.8 ± 1.8). Varices were rectal (12), stomal (8), duodenal (4) and at other sites (4). Concomitant variceal embolization was performed in five. Portal pressure gradient fell from 18.2 ± 6.4 to 7.2 ± 3.5 mmHg. TIPSS achieved haemostasis in six of nine patients who presented with active bleeding. Five patients rebled from ectopic varices. This was related to shunt dysfunction in two and responded to shunt interventions. Three patients rebled despite a functional shunt. Of these, thrombin controlled bleeding in one. Eight patients developed hepatic encephalopathy post-TIPSS.
Conclusions Transjugular intrahepatic portosystemic stent shunt is a safe and effective treatment for bleeding ectopic varices. Rebleeding from ectopic varices related to shunt dysfunction responds to shunt intervention. A significant proportion of patients have rebleeding despite a patent shunt, when other adjunctive measures like thrombin injection may be tried.