Transjugular Intrahepatic Portosystemic Shunt Creation and Variceal Coil or Plug Embolization Ineffectively Attain Gastric Variceal Decompression or Occlusion: Results of a 26-Patient Retrospective Study

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• 作者：Janesh Lakhoo ; BS^a ; James T. Bui ; MD^b ; R. Peter Lokken ; MD^b ; Charles E. Ray Jr ; MD ; PhD^b ; Ron C. Gaba ; MD^b ; ^{rgaba@uic.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：BATO ; balloon-occluded antegrade transvenous obliteration ; BRTO ; balloon-occluded retrograde transvenous obliteration ; CAQ ; Certificate of Added Qualifications ; EGD ; esophagogastroduodenoscopy ; EV ; esophageal varix ; GEV ; gastroesophageal varix ; GV ; gastric varix ; IGV ; isolated gastric varix ; LGV ; left gastric vein ; PGV ; posterior gastric vein ; PSG ; portosystemic gradient ; SGV ; short gastric vein ; TIPS ; transjugular intrahepatic portosystemic shunt
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：27
• 期：7
• 页码：1001-1011
• 全文大小：5819 K

文摘

To assess the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation with or without variceal coil and/or plug embolization in decompressing or occluding gastric varices (GVs).

Materials and Methods

In this retrospective study, 78 patients with GV bleeding who underwent TIPS creation with or without embolotherapy with metallic coils and/or plugs from 1999 to 2014 were identified. Individuals who had a bare-metal TIPS and/or lacked post-TIPS imaging or endoscopic follow-up were excluded. The final cohort included 26 patients (16 men; median age, 54 y; median Model for End-stage Liver Disease score, 16). Variceal types, supplying vessels, and postprocedure GV patency on cross-sectional imaging or endoscopy were assessed. The primary study outcome measure was GV patency rate as a surrogate for efficacy of TIPS creation with or without embolization.

Results

GVs included gastroesophageal varix types 1 (n = 10) and 2 (n = 2), isolated GV types 1 (n = 4) and 2 (n = 2), and unspecified (n = 8). TIPS creation resulted in a median final portosystemic pressure gradient of 7 mm Hg. Multiple GV-supplying vessels (left/posterior/short gastric veins) were present in 65% of patients (n = 17). Embolization was performed in 69% (n = 18). Thirteen, four, and nine patients had imaging, endoscopic, or both imaging/endoscopic follow-up. GV patency rate was 65% (n = 17; 61%/75% with/without embolization) at a median of 128.5 days (range, 1–1,295 d) after TIPS creation. Incidence of recurrent bleeding was 27% (n = 7), and the 90-day mortality rate was 15% (n = 4).

Conclusions

In this study, most GVs showed persistent patency despite TIPS decompression and variceal embolization, and the incidence of recurrent bleeding was high. The findings suggest suboptimal efficacy for GVs, and indicate a need for study of alternative or adjunctive approaches to GV treatment, such as chemical obliteration.