Effects of Adjuvant Chinese Patent Medicine Therapy on Prevention of Variceal Rebleeding:A Retrospective Cohort Study

Objective To assess whether adjuvant Chinese patent medicines(CPMs)to standard treatment could reduce recurrent bleeding after variceal bleeding in cirrhotic patients.Methods This study retrospectively collected 555 consecutive patients who recovered from variceal bleeding.A population-based cohort study was established depending on if adjuvant CPMs were administered to prevent rebleeding.A total of 139 patients who had taken⩾28 cumulative defined daily doses(cDDDs)of CPMs were included in the CPMs cohort,and 416 patients who used<28 cDDDs of CPMs were enrolled in the non-CPMs cohort.On evaluation of rebleeding incidence,1:2 propensity score matched was used to estimate for reducing bias.Patients were followed for at least 12 months.The end-point of this study was clinically significant esophagogastric variceal rebleeding.Results Following multivariate analysis,CPMs therapy was an independent factor for variceal rebleeding[adjusted hazard ratio(AHR)=0.657;95%confidence interval=0.497-0.868;P=0.003].After the 1:2 propensity score matching,a significant reduction(23.5%)in the incidence of variceal rebleeding in patients was observed,from 58.3%in the non-CPMs cohort to 44.6%in the CPMs cohort(modified log-rank test,P=0.002)within a year.The AHRs for rebleeding were 0.928,0.553,and 0.105,for 28-90 cDDDs,91-180 cDDDs,and>180 cDDDs of CPMs,respectively.The median rebleeding interval in the CPMs cohort was significantly larger compared with the non-CPMs cohort(113.5 vs.93.0 days;P=0.008).Conclusion Adjuvant CPMs to standard therapy can significantly reduce the incidence of variceal rebleeding and delay the time to rebleeding.

Transjugular intrahepatic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein

Background: Treatment options for patients with cavernous transformation of portal vein(CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV. Methods: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. All patients were diagnosed with CTPV. The indication for TIPS was a previous episode of variceal bleeding. The data on recurrent bleeding, stent patency, hepatic encephalopathy and survival were retrieved and analyzed. Results: TIPS procedure was successfully performed in 56 out of 67(83.6%) patients with CTPV. TIPS was performed via a transjugular approach alone( n = 15), a combined transjugular/transhepatic approach( n = 33) and a combined transjugular/transsplenic approach( n = 8). Mean portosystemic pressure gradient(PSG) decreased from 28.09 ± 7.28 mmHg to 17.53 ± 6.12 mmHg after TIPS( P < 0.01). The probability of the remaining free recurrent variceal bleeding was 87.0%. The probability of TIPS patency reached 81.5%. Hepatic encephalopathy occurrence was 27.8%, and survival rate was 88.9% until the end of follow-up. Four out of 11 patients who failed TIPS died, and 4 had recurrent bleeding. Conclusions: TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV, and to achieve clinical improvement.

Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application: A comparison study

BACKGROUND It is controversial whether transjugular intrahepatic portosystemic shunt(TIPS)placement can improve long-term survival.AIM To assess whether TIPS placement improves survival in patients with hepaticvenous-pressure-gradient(HVPG)≥16 mmHg,based on HVPG-related risk stratification.METHODS Consecutive variceal bleeding patients treated with endoscopic therapy+nonselectiveβ-blockers(NSBBs)or covered TIPS placement were retrospectively enrolled between January 2013 and December 2019.HVPG measurements were performed before therapy.The primary outcome was transplant-free survival;secondary endpoints were rebleeding and overt hepatic ence-phalopathy(OHE).RESULTS A total of 184 patients were analyzed(mean age,55.27 years±13.86,107 males;102 in the EVL+NSBB group,82 in the covered TIPS group).Based on the HVPG guided risk stratification,70 patients had HVPG<16 mmHg,and 114 patients had HVPG≥16 mmHg.The median follow-up time of the cohort was 49.5 mo.There was no significant difference in transplant-free survival between the two treatment groups overall(hazard ratio[HR],0.61;95%confidence interval[CI]:0.35-1.05;P=0.07).In the high-HVPG tier,transplant-free survival was higher in the TIPS group(HR,0.44;95%CI:0.23-0.85;P=0.004).In the low-HVPG tier,transplantfree survival after the two treatments was similar(HR,0.86;95%CI:0.33-0.23;P=0.74).Covered TIPS placement decreased the rate of rebleeding independent of the HVPG tier(P<0.001).The difference in OHE between the two groups was not statistically significant(P=0.09;P=0.48).CONCLUSION TIPS placement can effectively improve transplant-free survival when the HVPG is greater than 16 mmHg.