Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study

被引：158

作者：

Hernandez-Gea, Virginia ^{[1
,2
]}

Procopet, Bogdan ^{[3
,4
]}

Giraldez, Alvaro ^{[5
]}

Amitrano, Lucio ^{[6
]}

Villanueva, Candid ^{[2
,7
,8
]}

Thabut, Dominique ^{[9
]}

Ibanez-Samaniego, Luis ^{[10
]}

Silva-Junior, Gilberto ^{[1
]}

Martinez, Javier ^{[11
]}

Genesca, Joan ^{[2
,8
,12
]}

Bureau, Christophe ^{[13
]}

Trebicka, Jonel ^{[14
,15
,16
,17
]}

Llop, Elba ^{[2
,18
]}

Laleman, Wim ^{[19
]}

Maria Palazon, Jose ^{[20
]}

Castellote, Jose ^{[21
]}

Rodrigues, Susana ^{[22
]}

Gluud, Lise L. ^{[23
]}

Ferreira, Carlos Noronha ^{[24
]}

Barcelo, Rafael ^{[25
]}

Canete, Nuria ^{[26
]}

Rodriguez, Manuel ^{[27
]}

Ferlitsch, Arnulf ^{[28
]}

Luis Mundi, Jose ^{[29
]}

Gronbaek, Henning ^{[30
]}

Hernandez-Guerra, Manuel ^{[31
]}

Sassatelli, Romano ^{[32
]}

Dell'Era, Alessandra ^{[33
]}

Senzolo, Marco ^{[34
]}

Abraldes, Juan G. ^{[35
]}

Romero-Gomez, Manuel ^{[2
,36
]}

Zipprich, Alexander ^{[37
]}

Casas, Meritxell ^{[38
]}

Masnou, Helena ^{[39
]}

Primignani, Massimo ^{[40
]}

Krag, Aleksander ^{[17
]}

Nevens, Frederik ^{[19
]}

Luis Calleja, Jose ^{[2
,18
]}

Jansen, Christian ^{[14
]}

Robic, Marie Angele ^{[13
]}

Conejo, Irene ^{[2
,8
,12
]}

Catalina, Maria-Vega ^{[2
,10
]}

Albillos, Agustin ^{[2
,11
]}

Rudler, Marika ^{[9
]}

Alvarado, Edilmar ^{[2
,7
,8
]}

Guardascione, Maria Anna ^{[6
]}

Tantau, Marcel ^{[3
,4
]}

Bosch, Jaime ^{[1
,2
,41
]}

Torres, Ferran ^{[25
,42
]}

Carlos Garcia-Pagan, Juan ^{[1
,2
]}

机构：

[1] Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain

[2] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[3] Reg Inst Gastroenterol & Hepatol Octavian Fodor, Hepatol Dept, Cluj Napoca, Romania

[4] Iuliu Hatieganu Univ Med & Pharm, Med Clin 3, Cluj Napoca, Romania

[5] Univ Hosp Virgen del Rocio, Clin Management Unit Digest Dis, Seville, Spain

[6] Osped A Cardarelli, Gastroenterol Unit, Naples, Italy

[7] Hosp Santa Creu & Sant Pau, Serv Patol Digest, Barcelona, Spain

[8] CIBERehd, Barcelona, Spain

[9] Grp Hosp Pitie Salpetriere Charles Foix, Paris, France

[10] Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest Gregorio Maranon, IiSGM, CIBERehd, Barcelona, Spain

[11] Univ Alcala, Hosp Univ Ramon & Cajal, Dept Gastroenterol, CIBERehd,IRYCIS, Madrid, Spain

[12] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Vall dHebron Inst Res VHIR, Liver Unit, Barcelona, Spain

[13] Univ Toulouse, Dept Hepatogastroenterol, CHU Toulouse, Purpan Hosp,INSERM,U858, Toulouse, France

[14] Univ Bonn, Dept Internal Med 1, Bonn, Germany

[15] European Fdn Study Chron Liver Failure EF Clif, Barcelona, Spain

[16] Inst Bioengn Catalonia, Barcelona, Spain

[17] Odense Univ Hosp, Dept Gastroenterol & Hepatol, Odense, Denmark

[18] Univ Autonoma Madrid, CIBERehd, Liver Unit, Hosp Univ Puerta de Hierro, Madrid, Spain

[19] Univ Leuven, Dept Liver & Biliopancreat Disorders, Leuven, Belgium

[20] Hosp Gen Univ Alicante, Alicante, Spain

[21] Univ Barcelona, Hosp Univ Bellvitge, Dept Gastroenterol, Hepatol Unit,IDIBELL, Barcelona, Spain

[22] Ctr Hosp Sao Joao, Dept Gastroenterol & Hepatol, Porto, Portugal

[23] Univ Copenhagen, Hvidovre Univ Hosp, Fac Hlth & Med Sci, Gastrounit,Med Div, Copenhagen, Denmark

[24] Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal

[25] Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer, Med Stat Core Facil, Barcelona, Spain

[26] Univ Autonoma Barcelona, IMIM Hosp Mar Med Res Inst, Hosp Mar, Liver Sect,Gastroenterol Dept, Barcelona, Spain

[27] Hosp Cent Asturias, Dept Gastroenterol, Oviedo, Spain

[28] Med Univ Vienna, Div Gastroenterol & Hepatol, Dept Internal Med 3, Vienna, Austria

[29] Univ Hosp San Cecilio, Dept Gastroenterol, Granada, Spain

[30] Aarhus Univ Hosp, Dept Gastroenterol & Hepatol, Aarhus, Denmark

[31] Univ Hosp Canary Isl, Dept Gastroenterol, Tenerife, Spain

[32] Arcispedale Santa Maria Nuova IRCCS, Unit Gastroenterol & Digest Endoscopy, Reggio Emilia, Italy

[33] Univ Milan, Dept Clin & Biomed Sci, ASST Fatebenefratelli Sacco, Gastroenterol Unit, Milan, Italy

[34] Univ Hosp Padua, Dept Surg Oncol & Gastroenterol, Multivisceral Transplant Unit, Gastroenterol, Padua, Italy

[35] Univ Alberta, CEGIIR, Cirrhosis Care Clin, Div Gastroenterol,Liver Unit, Edmonton, AB, Canada

[36] Hosp Univ Valme, CIBERehd, Unidad Hepatol, Seville, Spain

[37] Martin Luther Univ Halle Wittenberg, Dept Internal Med 1, Halle, Saale, Germany

[38] Univ Autonoma Barcelona, Hosp Sabadell, Digest Dis Dept, Hepatol Unit, Sabadell, Spain

[39] Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Badalona, Spain

[40] Univ Milan, IRCCS Ca Granda Maggiore Hosp Fdn, Div Gastroenterol & Hepatol, Milan, Italy

[41] Bern Univ, Swiss Liver Ctr, Inselspital, Bern, Switzerland

[42] Univ Autonoma Barcelona, Fac Med, Biostat Unit, Barcelona, Spain

来源：

HEPATOLOGY | 2019年 / 69卷 / 01期

基金：

欧盟地平线“2020”;

关键词：

INTRAHEPATIC PORTOSYSTEMIC SHUNT; AMERICAN ASSOCIATION; PRACTICE GUIDELINE; LIVER-DISEASES; CIRRHOSIS; MORTALITY; EPIDEMIOLOGY; PLACEMENT; SURVIVAL; PRESSURE;

D O I：

10.1002/hep.30182

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.

引用

页码：282 / 293

页数：12

共 20 条

[1] Predicting Early Mortality After Acute Variceal Hemorrhage Based on Classification and Regression Tree Analysis [J].