Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding

Xiangguo Tian; Yongjun Shi; Jinhua Hu; Guangchuan Wang; Chunqing Zhang

doi:10.1007/s12072-013-9433-4

Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding

Hepatol Int. 2013 Jun;7(2):636-44. doi: 10.1007/s12072-013-9433-4. Epub 2013 Mar 13.

Authors

Xiangguo Tian¹, Yongjun Shi¹, Jinhua Hu¹, Guangchuan Wang¹, Chunqing Zhang²

Affiliations

¹ Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, People's Republic of China.
² Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, People's Republic of China. zhchqing@medmail.com.cn.

PMID: 26201796
DOI: 10.1007/s12072-013-9433-4

Abstract

Purpose: To compare the long-term results of modified percutaneous transhepatic variceal embolization with cyanoacrylate (PTVE) and the transjugular intrahepatic portal systemic shunt (TIPS) for treating esophageal variceal bleeding.

Methods: Patients with cirrhosis and variceal bleeding who underwent TIPS and PTVE with cyanoacrylate between January 2006 and December 2010 were selected. We performed chart reviews to determine the rebleeding rate, survival and the rate of encephalopathy.

Results: This retrospective study included 96 PTVE patients and 43 TIPS patients, with a median follow-up of 30.4 and 31.6 months in the two groups, respectively. Rebleeding occurred in 13 patients (30.2 %) in the TIPS group and in 20 patients (20.8 %) in the PTVE group (p = 0.229). For patients with model for end-stage liver disease (MELD) scores >18 at 1, 3 and 5 years, the survival rates were 84.2, 39.9 and 16.0 %, respectively, in the TIPS group, and they were 96.7, 72.0 and 36.0 %, respectively, in the PTVE group (p = 0.037). Sixteen (16.7 %) PTVE patients and 25 (58.1 %) TIPS patients developed encephalopathy (p = 0.000). Mean MELD and Child-Pugh scores improved significantly in modified PTVE patients. However, no such changes were observed in TIPS patients.

Conclusions: PTVE and TIPS were comparable in terms of variceal rebleeding prevention. However, in >18-MELD-score patients, PTVE offered better survival than TIPS. In addition, PTVE offered lower incidence of encephalopathy than TIPS.

Keywords: Cyanoacrylate; Esophageal varices; Percutaneous transhepatic variceal embolization (PTVE); Rebleeding; Transjugular intrahepatic portal systemic shunt (TIPS).