Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2023; 29(22): 3519-3533
Published online Jun 14, 2023. doi: 10.3748/wjg.v29.i22.3519
Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application: A comparison study
Xi-Xuan Wang, Xiao-Chun Yin, Li-Hong Gu, Hui-Wen Guo, Yang Cheng, Yan Liu, Jiang-Qiang Xiao, Yi Wang, Wei Zhang, Xiao-Ping Zou, Lei Wang, Ming Zhang, Yu-Zheng Zhu-Ge, Feng Zhang
Xi-Xuan Wang, Xiao-Chun Yin, Li-Hong Gu, Yang Cheng, Yan Liu, Jiang-Qiang Xiao, Yi Wang, Wei Zhang, Xiao-Ping Zou, Lei Wang, Ming Zhang, Yu-Zheng Zhu-Ge, Feng Zhang, Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China
Xi-Xuan Wang, Yu-Zheng Zhu-Ge, Medical School, Southeast University, Nanjing 210000, Jiangsu Province, China
Hui-Wen Guo, Department of Gastroenterology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
Author contributions: Wang XX and Yin XC contributed equally to this work; Zhang F, Zhu-Ge YZ, Wang XX contributed to the conceptualization; Wang XX, Yin XC, Gu LH, Guo HW, Cheng Y, Liu Y contributed to the data curation; Zhang F, Zhu-Ge YZ, Wang XX contributed to the formal analysis; Zhang F acquired the funding; Wang XX, Yin XC, Gu LH, Guo HW, Cheng Y, Liu Y contributed to the investigation; Zhang F, Zhu-Ge YZ, Zhang M, Xiao JQ, Wang Y, Zhang W contributed to the methodology; Zhang F, Zhu-Ge YZ, Zhang M administered the project; Wang L, Zou XP contributed to the resources; Wang L, Zou XP utilized the software; Zhang F, Zhu-Ge YZ, Zhang M contributed to the supervision; Wang XX, Yin XC, Gu LH, Guo HW contributed to the validation; Wang XX, Yin XC contributed to the visualization; Wang XX wrote the original draft; Zhang F, Zhu-Ge YZ reviewed and edited the draft; all authors have read and approve the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81900552; Nanjing Health Science, Technology Development Special Fund Project-Key project, No. ZKX19015; Outstanding Youth Fund project, No. JQX20005; Funding for Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University, No. 2022-LCYJ-MS-13.
Institutional review board statement: The study was reviewed and approved for publication by our institutional (Nanjing Drum Tower Hospital) reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent for personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: No authors have conflicts of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available upon request from the corresponding author at fzdndx@126.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Zhang, MD, Doctor, Professor, Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210000, Jiangsu Province, China. fzdndx@126.com
Received: January 3, 2023
Peer-review started: January 3, 2023
First decision: March 8, 2023
Revised: March 15, 2023
Accepted: May 17, 2023
Article in press: May 17, 2023
Published online: June 14, 2023
Processing time: 154 Days and 22.7 Hours
Abstract
BACKGROUND

It is controversial whether transjugular intrahepatic portosystemic shunt (TIPS) placement can improve long-term survival.

AIM

To assess whether TIPS placement improves survival in patients with hepatic-venous-pressure-gradient (HVPG) ≥ 16 mmHg, based on HVPG-related risk stratification.

METHODS

Consecutive variceal bleeding patients treated with endoscopic therapy + nonselective β-blockers (NSBBs) or covered TIPS placement were retrospectively enrolled between January 2013 and December 2019. HVPG measurements were performed before therapy. The primary outcome was transplant-free survival; secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE).

RESULTS

A total of 184 patients were analyzed (mean age, 55.27 years ± 13.86, 107 males; 102 in the EVL+NSBB group, 82 in the covered TIPS group). Based on the HVPG-guided risk stratification, 70 patients had HVPG < 16 mmHg, and 114 patients had HVPG ≥ 16 mmHg. The median follow-up time of the cohort was 49.5 mo. There was no significant difference in transplant-free survival between the two treatment groups overall (hazard ratio [HR], 0.61; 95% confidence interval [CI]: 0.35-1.05; P = 0.07). In the high-HVPG tier, transplant-free survival was higher in the TIPS group (HR, 0.44; 95%CI: 0.23-0.85; P = 0.004). In the low-HVPG tier, transplant-free survival after the two treatments was similar (HR, 0.86; 95%CI: 0.33-0.23; P = 0.74). Covered TIPS placement decreased the rate of rebleeding independent of the HVPG tier (P < 0.001). The difference in OHE between the two groups was not statistically significant (P = 0.09; P = 0.48).

CONCLUSION

TIPS placement can effectively improve transplant-free survival when the HVPG is greater than 16 mmHg.

Keywords: Hepatic venous pressure gradient; Transjugular intrahepatic portosystemic shunts; Cirrhosis; Variceal rebleeding; Survival

Core Tip: Hepatic venous pressure gradient helps clinicians to assess the prognosis of decompensated cirrhotic patients. The study included 184 patients showed that hepatic-venous-pressure-gradient (HVPG) before therapy as a risk stratification provides prognostic value. Treatment can be given with greater confidence with the management of patients by HVPG.