Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage

A randomized, controlled trial

Arun J. Sanyal, Arthur M. Freedman, Velimir A. Luketic, Preston P. Purdum, Mitchell L. Shiffman, Patricia E. Cole, Jaime Tisnado, Sharon Simmons

Research output: Contribution to journalArticle

Abstract

Background: Transjugular intrahepatic portosystemic shunts (TIPS) have widened the use of portal decompression as therapy for variceal hemorrhage. However, no controlled studies have examined the efficacy of TIPS compared with that of other treatments. Objective: To compare the efficacy and safety of TIPS with those of endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage. Design: Randomized, controlled trial. Setting: Tertiary-care academic medical center. Patients: 100 patients with cirrhosis were evaluated a mean of approximately 10 days after an episode of acute variceal bleeding; 20 patients were excluded because of portal venous thrombosis (n = 6), hepatoma (n =3), florid alcoholic hepatitis (n =6), and refusal to give consent (n =5). Interventions: TIPS (n =41) or sclerotherapy (n =39). The latter was performed by freehand injections of 5% Na morrhuate at 2- to 3-week intervals. Recurrent variceal hemorrhage was managed by sclerotherapy followed by angiographic assessment of TIPS and dilatation of the stents (TIPS group) or crossover to TIPS (sclerotherapy group). Measurements: Rebleeding and survival were the primary end points. Complications and rates of rehospitalization were secondary end points. Results: During a mean follow-up of approximately 1000 days, recurrent gastrointestinal bleeding resulted from variceal hemorrhage (9 patients in the TIPS group and 8 in the sclerotherapy group), portal gastropathy (1 patient in each group), and gastric lipoma (0 and 1 patients, respectively). A higher mortality rate was seen with TIPS (P = 0.03). Death resulted from variceal bleeding (5 patients in the TIPS group and 3 in the sclerotherapy group), sepsis (3 and 2 patients, respectively), liver failure (2 patients in each group), hepatoma (1 and 0 patients, respectively), and hemoperitoneum (1 and 0 patients, respectively). Encephalopathy was the most common complication in the TIPS group (n = 12), and pain developing after sclerotherapy was the most common in the sclerotherapy group (n = 10). The two groups had similar rates of rehospitalization. Conclusions: Endoscopic sclerotherapy and TIPS are equivalent with respect to rebleeding developing over the long term. However, sclerotherapy may be superior to TIPS with respect to survival.

Original languageEnglish (US)
Pages (from-to)849-857
Number of pages9
JournalAnnals of internal medicine
Volume126
Issue number11
DOIs
StatePublished - Jun 1 1997

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Transjugular Intrahepatic Portasystemic Shunt
Sclerotherapy
Randomized Controlled Trials
Hemorrhage
Hepatocellular Carcinoma
Alcoholic Hepatitis
Hemoperitoneum
Survival
Lipoma
Liver Failure
Brain Diseases
Tertiary Healthcare
Decompression
Venous Thrombosis
Stents

ASJC Scopus subject areas

  • Internal Medicine

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Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage : A randomized, controlled trial. / Sanyal, Arun J.; Freedman, Arthur M.; Luketic, Velimir A.; Purdum, Preston P.; Shiffman, Mitchell L.; Cole, Patricia E.; Tisnado, Jaime; Simmons, Sharon.

In: Annals of internal medicine, Vol. 126, No. 11, 01.06.1997, p. 849-857.

Research output: Contribution to journalArticle

Sanyal, Arun J. ; Freedman, Arthur M. ; Luketic, Velimir A. ; Purdum, Preston P. ; Shiffman, Mitchell L. ; Cole, Patricia E. ; Tisnado, Jaime ; Simmons, Sharon. / Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage : A randomized, controlled trial. In: Annals of internal medicine. 1997 ; Vol. 126, No. 11. pp. 849-857.
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abstract = "Background: Transjugular intrahepatic portosystemic shunts (TIPS) have widened the use of portal decompression as therapy for variceal hemorrhage. However, no controlled studies have examined the efficacy of TIPS compared with that of other treatments. Objective: To compare the efficacy and safety of TIPS with those of endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage. Design: Randomized, controlled trial. Setting: Tertiary-care academic medical center. Patients: 100 patients with cirrhosis were evaluated a mean of approximately 10 days after an episode of acute variceal bleeding; 20 patients were excluded because of portal venous thrombosis (n = 6), hepatoma (n =3), florid alcoholic hepatitis (n =6), and refusal to give consent (n =5). Interventions: TIPS (n =41) or sclerotherapy (n =39). The latter was performed by freehand injections of 5{\%} Na morrhuate at 2- to 3-week intervals. Recurrent variceal hemorrhage was managed by sclerotherapy followed by angiographic assessment of TIPS and dilatation of the stents (TIPS group) or crossover to TIPS (sclerotherapy group). Measurements: Rebleeding and survival were the primary end points. Complications and rates of rehospitalization were secondary end points. Results: During a mean follow-up of approximately 1000 days, recurrent gastrointestinal bleeding resulted from variceal hemorrhage (9 patients in the TIPS group and 8 in the sclerotherapy group), portal gastropathy (1 patient in each group), and gastric lipoma (0 and 1 patients, respectively). A higher mortality rate was seen with TIPS (P = 0.03). Death resulted from variceal bleeding (5 patients in the TIPS group and 3 in the sclerotherapy group), sepsis (3 and 2 patients, respectively), liver failure (2 patients in each group), hepatoma (1 and 0 patients, respectively), and hemoperitoneum (1 and 0 patients, respectively). Encephalopathy was the most common complication in the TIPS group (n = 12), and pain developing after sclerotherapy was the most common in the sclerotherapy group (n = 10). The two groups had similar rates of rehospitalization. Conclusions: Endoscopic sclerotherapy and TIPS are equivalent with respect to rebleeding developing over the long term. However, sclerotherapy may be superior to TIPS with respect to survival.",
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T1 - Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage

T2 - A randomized, controlled trial

AU - Sanyal, Arun J.

AU - Freedman, Arthur M.

AU - Luketic, Velimir A.

AU - Purdum, Preston P.

AU - Shiffman, Mitchell L.

AU - Cole, Patricia E.

AU - Tisnado, Jaime

AU - Simmons, Sharon

PY - 1997/6/1

Y1 - 1997/6/1

N2 - Background: Transjugular intrahepatic portosystemic shunts (TIPS) have widened the use of portal decompression as therapy for variceal hemorrhage. However, no controlled studies have examined the efficacy of TIPS compared with that of other treatments. Objective: To compare the efficacy and safety of TIPS with those of endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage. Design: Randomized, controlled trial. Setting: Tertiary-care academic medical center. Patients: 100 patients with cirrhosis were evaluated a mean of approximately 10 days after an episode of acute variceal bleeding; 20 patients were excluded because of portal venous thrombosis (n = 6), hepatoma (n =3), florid alcoholic hepatitis (n =6), and refusal to give consent (n =5). Interventions: TIPS (n =41) or sclerotherapy (n =39). The latter was performed by freehand injections of 5% Na morrhuate at 2- to 3-week intervals. Recurrent variceal hemorrhage was managed by sclerotherapy followed by angiographic assessment of TIPS and dilatation of the stents (TIPS group) or crossover to TIPS (sclerotherapy group). Measurements: Rebleeding and survival were the primary end points. Complications and rates of rehospitalization were secondary end points. Results: During a mean follow-up of approximately 1000 days, recurrent gastrointestinal bleeding resulted from variceal hemorrhage (9 patients in the TIPS group and 8 in the sclerotherapy group), portal gastropathy (1 patient in each group), and gastric lipoma (0 and 1 patients, respectively). A higher mortality rate was seen with TIPS (P = 0.03). Death resulted from variceal bleeding (5 patients in the TIPS group and 3 in the sclerotherapy group), sepsis (3 and 2 patients, respectively), liver failure (2 patients in each group), hepatoma (1 and 0 patients, respectively), and hemoperitoneum (1 and 0 patients, respectively). Encephalopathy was the most common complication in the TIPS group (n = 12), and pain developing after sclerotherapy was the most common in the sclerotherapy group (n = 10). The two groups had similar rates of rehospitalization. Conclusions: Endoscopic sclerotherapy and TIPS are equivalent with respect to rebleeding developing over the long term. However, sclerotherapy may be superior to TIPS with respect to survival.

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