Transjugular intrahepatic portosystemic shunt versus balloon-occluded transvenous obliteration for the management of ectopic varices

Document Type

Conference Proceeding

Publication Date

7-1-2022

Publication Title

J Hepatol

Keywords

sodium, adult, balloon, bleeding, clinical article, cohort analysis, conference abstract, controlled study, demographics, female, hepatic encephalopathy, human, interventional radiology, length of stay, male, mesentery, middle aged, mortality rate, paracentesis, retrospective study, transjugular intrahepatic portosystemic shunt, varicosis

Abstract

Background and aims: Bleeding ectopic or non-gastroesophageal varices occur uncommonly in the setting of portal hypertension. Both transjugular intrahepatic portosystemic shunt (TIPS) and balloonoccluded antegrade or retrograde transvenous obliteration (BA-RTO) are potential treatment options. Our study is the first to assess and compare TIPS vs. BA-RTO for the management of ectopic varices. Method: This is a retrospective cohort study at a tertiary liver center. All interventional radiology procedures performed for bleeding varices between 2006 and 2020 were identified. Only patients undergoing TIPS and BA-RTO for bleeding ectopic varices were included. Demographics, pre-procedural data and outcome data was collected and compared between BA-RTO and TIPS groups. Results: Eleven patients undergoing BA-RTOwere compared to seven patients undergoing TIPS. In 6 of the BA-RTO patients, TIPS was deemed unfeasible. Mean age at procedure was 55.6 ± 10.0. 55.6% were men and 83.3% were white. There were 8 rectal varices, 7 peristomal, one duodenal, one cecal and one superior mesenteric. The mean MELD-Na prior to procedures was 20.8 ± 10.4 in the BARTO group vs. 19.0 ± 6.4 in the TIPS groups (p = 0.69). In the BA-RTO vs. TIPS groups, respectively, the mean MELD-Na at 30 days after procedure was 18.8 ± 9.9 vs 21.7 ± 5.5 (p = 0.67) and at 90 days after procedure was 18.0 ± 4.2 vs 24.0 ± 7.5 (p = 0.39). Rebleeding rates during admission were 9.1% for BA-RTO vs. 14.3% for TIPS (p = 1.00). The mean length of stay for BA-RTO vs. TIPSwas 10.6 ± 8.9 vs. 7.9 ± 8.1 days (p = 0.41), mean paracenteses 90 days prior and after procedure were 1.9 ± 3.6 vs. 0.0 ± 0.0 (p = 0.12) and 2.0 ± 3.9 vs. 0.0 ± 0.0 (p = 0.082), in the BA-RTO vs TIPS groups, respectively. The rates of hepatic encephalopathy in the BA-RTO vs TIPS groups at 90 days before and after the procedurewere 45.4% vs. 57.1% (p = 1.00) and 28.6% vs 33.3% (p = 1.00), respectively. The mortality rates were 27.3% vs 28.6% (p = 1.00) in the BA-RTO vs TIPS groups. Conclusion: Our results demonstrate that both TIPS and BA-RTO are effective treatment modalities for bleeding ectopic varices, with comparable post-procedure outcomes. Patients undergoing BA-RTO had a higher MELD at procedure but lower MELD at 30 and 90 day post-procedure and less HE though no differences were significant. BA-RTO is an excellent option for bleeding ectopic varices, primarily rectal and peristomal, and especially in patients not candidates for TIPS.

Volume

77

First Page

S612

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