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Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding

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Abstract

Purpose

To compare the long-term results of modified percutaneous transhepatic variceal embolization with cyanoacrylate (PTVE) and the transjugular intrahepatic portal systemic shunt (TIPS) for treating esophageal variceal bleeding.

Methods

Patients with cirrhosis and variceal bleeding who underwent TIPS and PTVE with cyanoacrylate between January 2006 and December 2010 were selected. We performed chart reviews to determine the rebleeding rate, survival and the rate of encephalopathy.

Results

This retrospective study included 96 PTVE patients and 43 TIPS patients, with a median follow-up of 30.4 and 31.6 months in the two groups, respectively. Rebleeding occurred in 13 patients (30.2 %) in the TIPS group and in 20 patients (20.8 %) in the PTVE group (p = 0.229). For patients with model for end-stage liver disease (MELD) scores >18 at 1, 3 and 5 years, the survival rates were 84.2, 39.9 and 16.0 %, respectively, in the TIPS group, and they were 96.7, 72.0 and 36.0 %, respectively, in the PTVE group (p = 0.037). Sixteen (16.7 %) PTVE patients and 25 (58.1 %) TIPS patients developed encephalopathy (p = 0.000). Mean MELD and Child–Pugh scores improved significantly in modified PTVE patients. However, no such changes were observed in TIPS patients.

Conclusions

PTVE and TIPS were comparable in terms of variceal rebleeding prevention. However, in >18-MELD-score patients, PTVE offered better survival than TIPS. In addition, PTVE offered lower incidence of encephalopathy than TIPS.

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Acknowledgements

We would like to thank Dr. S.K. Sarin from the Institute of Liver and Biliary Sciences (ILBS), New Delhi, India, and Vijay Shah, M.D., from the Gastroenterology and Hepatology Mayo Clinic Transplant Center for their review and valuable comments on the manuscript. Thanks to Dr. Edward C. Mignot, Shandong University, for linguistic advice.

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Authors and Affiliations

  1. Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, People’s Republic of China

    Xiangguo Tian, Yongjun Shi, Jinhua Hu, Guangchuan Wang & Chunqing Zhang

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  1. Xiangguo Tian
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  2. Yongjun Shi
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Correspondence to Chunqing Zhang.

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Tian, X., Shi, Y., Hu, J. et al. Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding. Hepatol Int 7, 636–644 (2013). https://doi.org/10.1007/s12072-013-9433-4

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  • DOI: https://doi.org/10.1007/s12072-013-9433-4

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