Comparison of embolic agents for varices during transjugular intrahepatic portosystemic shunt for variceal bleeding: Tissue gel or coil?

Purpose:We aimed to compare treatment efficacy,safety and material cost between tissue gel and coil regarding variceal embolization during transjugular intrahepatic portosystemic shunt(TIPS).Materials&Methods:This retrospective study including cirrhotic patients with variceal bleeding treated with TIPS combined with variceal embolization between January 2016 and August 2017.Patients were divided into three groups according to embolic agents used in variceal embolization:tissue gel group(Group A),combination group(Group B),and coil group(Group C).The primary endpoint was 1-year rebleeding rate after TIPS creation.The secondary endpoints included shunt dysfunction,overt hepatic encephalopathy,liver function,and embolic agents-related expense.Results:A total of 60 patients(30,10,and 20 in Group A,B,and C)were included.Variceal rebleeding occurred in3(10%),0(0%),and 4(20%)patients within one year after TIPS creation in Group A,B,and C,respectively.Stent dysfunction occurred in 2(3.3%)patients and 9(15.0%)patients experienced overt hepatic encephalopathy.No significant differences were observed between three groups regarding primary and secondary endpoints except embolic agents-related expense,with a significantly lower cost in Group A when compared to the other two groups.Stent dysfunction occurred in two patients,with one patient in Group A developed acute occlusion caused by thrombus and another patient in Group C underwent stent stenosis during follow-up.Conclusions:Compares to coil alone or combines with coil,tissue gel has similar treatment efficacy and safety,but with significantly lower cost for variceal bleeding during TIPS.

Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding: A series of six cases and literature review

Objectives:To present a case series of modified transjugular intrahepatic portosystemic shunts(TIPS) and percutaneous transhepatic intrahepatic portosystemic shunts(PTIPS) in cirrhotic patients with variceal bleeding(VB).In addition,the scientific literature pertaining to PTIPS was reviewed.Methods:This retrospective clinical case series included six cirrhotic patients with VB who were treated with PTIPS after the failure of endoscopic band ligation or endoscopic injection sclerotherapy combined with vasoactive drugs.The treatment was conducted between January 2017 and June 2019 at a single institution.Three patients suffered from severe atrophy of the right or left lobar of the liver as well as the main right or left branch of the portal vein.The remaining three patients showed severe atrophy of the whole liver and portal vein,resulting in widening of the liver fissure.A paired t-test was used to compare the changes in portal pressure gradient between before and after the PTIPS operation.The rebleeding rate,treatment efficacy,complications,and technical success rate were all assessed during follow-up.Results:All six PTIPS procedures were performed successfully,with no severe procedural-related complications observed.None of the patients experienced VB during a mean follow-up of 22.8(range,18.0-28.0) months.The mean portosystemic pressure gradient decreased from 28.3 ± 4.3 mmHg pre-procedure to 12.3 ± 2.6 mmHg immediately post-procedure(P <0.001).At follow-up,one patient was found to have developed grade 2 hepatic encephalopathy thrice during the first year,according to the West Haven criteria.However,this was resolved following medical treatment.Conclusions:When the patient’s portal venous anatomy is unconducive to the performance of TIPS using the transjugular approach,PTIPS can be considered as a safe,effective complementary surgical approach for patients with VB.