Hu XG, Dai JJ, Lu J, Li G, Wang JM, Deng Y, Feng R, Lu KP. Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding. World J Gastrointest Surg 2024; 16(2): 471-480 [PMID: 38463371 DOI: 10.4240/wjgs.v16.i2.471]
Corresponding Author of This Article
Kai-Ping Lu, MM, Associate Chief Physician, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou 310000, Zhejiang Province, China. lukaiping158@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2024; 16(2): 471-480 Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.471
Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding
Xiao-Gang Hu, Jian-Ji Dai, Jun Lu, Gang Li, Jia-Min Wang, Yi Deng, Rui Feng, Kai-Ping Lu
Xiao-Gang Hu, Jian-Ji Dai, Jun Lu, Gang Li, Jia-Min Wang, Yi Deng, Department of Interventional Radiology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
Rui Feng, Department of Interventional Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Kai-Ping Lu, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Author contributions: Hu XG and Lu KP designed the study; Hu XG and Dai JJ wrote the manuscript; Hu XG, Lu J, Li G, Deng Y, and Wang JM performed the experiments; Hu XG, Dai JJ and Feng R analyzed the data; Lu KP revised and reviewed the manuscript; and all the authors read and approved the final manuscript.
Institutional review board statement: The study was approved by Ethics Committee of Affiliated Jinhua Hospital, Zhejiang University School of Medicine.
Informed consent statement: The data used in the study were not involved in the patients’ privacy information, and all patient data obtained, recorded, and managed only used for this study, without any harm to the patient. So the informed consent was waived by the Ethics Committee of Affiliated Jinhua Hospital, Zhejiang University School of Medicine.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Kai-Ping Lu, MM, Associate Chief Physician, Department of Vascular Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou 310000, Zhejiang Province, China. lukaiping158@126.com
Received: November 22, 2023 Peer-review started: November 22, 2023 First decision: December 8, 2023 Revised: December 15, 2023 Accepted: January 9, 2024 Article in press: January 9, 2024 Published online: February 27, 2024 Processing time: 95 Days and 6.3 Hours
ARTICLE HIGHLIGHTS
Research background
The transjugular intrahepatic portosystemic shunt (TIPS) is an important method for treating upper gastrointestinal bleeding caused by portal hypertension in patients with liver cirrhosis. Nevertheless, additional research endeavors are needed to elucidate the precise therapeutic efficacy of TIPS for managing variceal bleeding and to discern its implications for patient prognosis.
Research motivation
The primary objective of this study was to scrutinize the efficacy of TIPS for the management of esophageal-gastric variceal bleeding (EGVB) in individuals with cirrhosis and to evaluate its consequential influence on patient prognosis. This study endeavors to meticulously assess the advantageous outcomes associated with TIPS, aiming to furnish evidence-based insights that can inform and enhance clinical decision-making processes.
Research objectives
Through in-depth research on the therapeutic effect and prognosis of TIPS placement, this paper aimed to provide additional comprehensive information for clinical doctors to better guide treatment decision-making and improve disease management.
Research methods
A retrospective study was undertaken involving 92 patients afflicted with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022. The patient cohort was dichotomized into two groups based on distinct treatment modalities: The TIPS treatment group (n = 50) and the percutaneous transhepatic variceal embolization treatment group (n = 42). Comparative analyses were also conducted on the varicosity status, hemodynamic parameters, and quality of life of the patients in both groups, both preoperatively and postoperatively. Additionally, a comparative examination was undertaken to evaluate the 1-year rebleeding and survival rates between the two treatment groups.
Research results
Postoperative varicosity improved in both groups, with the study group showing better outcomes. Portal vein flow velocity increased and portal vein diameter decreased postoperatively, again with the study group demonstrating superior results. Postoperative platelet count and white blood cell counts were greater in both groups, and the study group had higher scores in all dimensions of life quality. Furthermore, compared with those in the control group, the one-year rebleeding rate in the study group was notably lower, although no significant difference was detected in the one-year postoperative survival rate between the two cohorts.
Research conclusions
TIPS treatment has demonstrated robust efficacy in the management of cirrhotic EGVB by significantly diminishing varicosity and enhancing hemodynamics in affected patients. This intervention not only represents a safer alternative but also contributes to a more favorable prognosis in this clinical context.
Research perspectives
Cirrhosis, as a grave and chronic ailment, profoundly influences both the quality of life and the life expectancy of afflicted individuals. Consequently, a thorough exploration of treatment modalities and prognosis pertaining to EGVB induced by cirrhosis is of paramount importance, as this review offers invaluable insights and reference points for clinicians engaged in clinical practice.
