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Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding

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Abstract

Background

The transjugular intrahepatic portosystemic shunt (TIPS) is effective for treating complications of portal hypertension in cirrhotic adults but the experience in children is limited.

Objective

To retrospectively review the safety and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS in children with acute or recurrent gastrointestinal bleeding.

Materials and methods

We reviewed the medical records of children who received implants of 10-mm-diameter PTFE-covered endoprostheses for acute or recurring upper gastrointestinal bleeding caused by medically or endoscopically uncontrollable varices. The recurrence of upper gastrointestinal bleeding, associated complications and permeability were assessed with Doppler sonography sequentially or up to transplantation.

Results

In all children (n = 12; mean age 9 years; mean weight 30 kg) a single endoprosthesis was implanted with no associated mortality. The mean initial transhepatic gradient was 15 mmHg (range 3–21 mmHg), dropping to 7 mmHg (range 1–12 mmHg) after TIPS. Immediate complications were mild encephalopathy (n = 1) and acute occlusion of the TIPS (n = 1). Stenosis of the TIPS was observed in two children, at 9 months and 54 months follow-up, and thrombosis was observed in two children, at 7 months and 12 months follow-up. All four stenoses/occlusions were resolved with coaxial endoprostheses.

Conclusion

The safety profile and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS were satisfactory in this small series of children with acute or recurrent gastrointestinal bleeding.

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Acknowledgements

The authors thank J.A. Miñano for supporting the estimation of fluoroscopic radiation doses.

Conflicts of interest

None

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Authors and Affiliations

  1. Interventional Radiology Unit, Hospital Universitario Reina Sofía, Menendez Pidal s/n, 14004, Córdoba, Spain

    Luis J. Zurera, Juan J. Espejo, Sagrario Lombardo & Miguel Canis

  2. Paediatric Gastroenterology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain

    Juan J. Gilbert

  3. Anaesthesiology Department, Hospital Universitario Reina Sofía, Córdoba, Spain

    Concepción Ruiz

Authors
  1. Luis J. Zurera
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  2. Juan J. Espejo
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  3. Sagrario Lombardo
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  4. Juan J. Gilbert
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  5. Miguel Canis
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  6. Concepción Ruiz
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Correspondence to Sagrario Lombardo.

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Zurera, L.J., Espejo, J.J., Lombardo, S. et al. Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding. Pediatr Radiol 45, 422–429 (2015). https://doi.org/10.1007/s00247-014-3181-z

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  • DOI: https://doi.org/10.1007/s00247-014-3181-z

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