The Results of Long-term Follow-up after Transjugular Intrahepatic Portosystemic Shunt for Gastric and Esophageal Bleeding

Kim, Young Tak; Kwen, Hyek Man; Kim, Dae Hyun; Kum, Min Su; Kwen, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo; Kim, Yong Joo

Abstract

BACKGROUND/AIMS: Transjugular intrahepatic portosystemic shunt(TIPS) is a promising method of treatment for gastric and esophageall variceal bleeding. Immediate technical and short-term clinical results have been reportn!. This study is performed to evaluate long-term outcome after TIPS in patients who underwent the pracedure for variceal bleeding.
METHODS
Forty patients who underwent TIPS hetween August 1991 and February 199S were followed up by clinical examination, upper gastrointestina! Endoscopy and Duplex sonogrphy.
RESULTS
The mean portohepatic pressure gradient prior to TIPS was 30.1+/-8.7cmH ancl dropped to 16.6+/-6.7cmH2O after shunt(p<0.001). The cumulative survival rate was 67.5% at 6 months. 57.4% at 1 year, 37.1% at 2 years and 26.8% at 3 years. Survival after TIPS was inversely related to Child-Pugh class. The incidence of recurrent variceal bleeding was 25%. The causes of death were hepatic failure(53.6 %), recurrent variceal bleeding(28.6'%), sepsis(7.1 %) and unknown causes(10.7'%).
CONCLUSION
TIPS is an effective method for treatment of variceal bleeding in unsuccessful cases by other treatments including endoscopic therapy and the most important prognostic factor is preprocedual hepatic resenre(Child-Pugh class), TIPS by itself is not defioite therapy, but in combination with careful follow-up surveillance and percutaneous shunt revision is very effective therapeutic strategy. TIPS is particularly valuable in tlreating patients with variceal bleeding hefor liver transplantation and in treating patients with poor liver function.