PWE-125 Transjugular intrahepatic portosystemic shunt insertion is safe and effective in district general hospital setting

Introduction Transjugular intrahepatic portosystemic shunt (TIPS) insertion is a recognised rescue treatment for uncontrollable bleeding due to portal hypertension and can also be used for refractory ascites. TIPS is usually performed by interventional radiology (IR) and normally in a 'teaching' hospital setting. Reported mortality rates are 27-50%.1 At our institution, a large DGH, a 24-hour IR-led TIPS service has been established since 2007. The aim of this study was to assess technical success, complications and mortality associated with TIPS. Method Using a TIPS database, we conducted analysis of patients who had undergone a TIPS procedure between 2007 and 2014. Data collected included demographics, indication, success rate, short and long term complications and mortality. A total of 32 patients were identified and case notes were available for 25. Results Of the 25 patients identified, 18 (72%) were male. The mean age was 48.4 (25-73.) Child-s score was A in 5 (20%), B in 11 (44%) and C in 9 (36%). Six patients (24%) had a MELD 18. The commonest underlying aetiology was alcohol in 12 (48%), alcohol and HCV in 6 (24%) and NASH in 3 (12%). The commonest indication was uncontrolled/recurrent bleeding in 18 (60%), gastric varices in 3 (12%) and refractory ascites in 4 (16%). Six (24%) had undergone OGD once before TIPS, 9 (36%) had 2 OGDs and 4 (16%) had 3. Technical success was achieved in 23 (92%). Two patients underwent further TIPS refashioning. There was one TIPS thrombosis soon after insertion. Of 21 patients receiving TIPS for bleeding, 18 (86%) required no further endoscopies. Three patients rebled (14%) requiring repeated endoscopy. There were no significant procedure-related complications. Severe refractory hepatic encephalopathy occurred in only 1 patient (4%). The 30-day mortality was 28% (7 patients) and 1-year mortality was 44% (11). Most deaths occurred in patients with Child-s C disease (4 patients at 30-days and 7 at 1-year) with no 30-day mortality in Child-s A. Three patients aged over 65 underwent TIPS, 2 died within 30 days (Child-s B) and 1 within 1 year (Child-s A.) All patients who died had a MELD score >15. The commonest cause of death was either rebleeding or multiorgan failure. Conclusion TIPS can be safely and effectively performed in a DGH setting with success, complication and mortality rates comparable to larger 'teaching' centres. As with other studies, severity of liver disease and age are