《2023年AASLD实践指南:TIPS、曲张静脉栓塞、逆行性经静脉栓塞治疗曲张静脉出血》摘译

An excerpt from the 2023 AASLD practice guidelines:TIPS,variceal embolization,and retrograde transvenous embolization for the treatment of variceal hemorrhage

该指南是美国肝病研究学会(AASLD)关于介入放射血管内技术在曲张静脉出血治疗应用中的综合指南, 是对AASLD"肝硬化门静脉高压出血风险分层和管理"指南的补充, 阐述了侵入性手术的最新进展。经颈静脉肝内门体分流术(TIPS)可追溯到20世纪80年代, 在过去的几年里, TIPS支架进行了一些新的技术改进。在北美, 胃静脉曲张出血的另一个主要治疗方法是采用不同形式的逆行性经静脉栓塞术。该指南旨在使医护人员深入了解TIPS和/或曲张静脉栓塞/闭塞术在曲张静脉出血治疗中的应用, 目的是促进肝病科、胃肠病科、介入放射科和外科之间在治疗策略上的多学科讨论。该指南为曲张静脉出血的血管内治疗提供了基于数据支持的方法。它不同于AASLD指南由文献的系统评价、证据质量的正式评级和建议的强度来支持。该指南在AASLD实践指南委员会的监督下, 由专家小组达成共识, 基于对相关主题文献的全面审查和分析提出指导性声明。AASLD实践指南委员会之所以选择该主题, 是因为大多数情况下, 在该主题上没有足够数量的随机对照试验提供有意义的系统综述和荟萃分析。

This is the American Association for the Study of Liver Diseases(AASLD)comprehensive guideline on the application of endovascular interventional radiological procedures in the treatment of variceal bleeding,which supplements Risk Stratification and Management of Portal Hypertensive Bleeding in Cirrhosis by describing recent advances in invasive surgery.Transjugular intrahepatic portosystemic shunt(TIPS)dates back to the 80s of the 20th century,and over the past few years,several new technical improvements have been made to TIPS stents.Another major treatment for gastric variceal bleeding in North America is the use of different forms of retrograde transvenous embolization.This guideline is intended to provide healthcare professionals with an in-depth understanding of the use of TIPS and/or variceal embolization/occlusion in the treatment of variceal bleeding,with the goal of facilitating multidisciplinary discussions on treatment strategies among hepatologists,gastroenterologists,interventional radiologists,and surgeons.Additionally,it provides a data-based approach to the endovascular treatment of variceal bleeding.However,it differs from the AASLD guidelines by being supported by a systematic review of the literature,a formal rating of the quality of the evidence,and the strength of the recommendations.Consequently,this guideline was developed by a consensus of an expert panel under the supervision of the AASLD Practice Guidelines Committee and provides guidance statements based on a comprehensive review and analysis of the literature on the relevant topic.Importantly,the AASLD Practice Guidelines Committee selected this topic because,for the most part,there are not a sufficient number of randomized controlled trials on this topic to provide meaningful systematic reviews and metaanalyses.