Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices
The optimal management of ruptured gastric varices in patients with cirrhosis has not been codified yet. The present study reports the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory gastric variceal bleeding. Thirty‐two consecutive patients were included. All...
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| Veröffentlicht in: | Hepatology (Baltimore, Md.) Md.), 1999-11, Vol.30 (5), p.1139-1143 |
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| container_title | Hepatology (Baltimore, Md.) |
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| creator | Barange, Karl Péron, Jean‐Marie Imani, Kamran Otal, Philippe Payen, Jean‐Louis Rousseau, Herve Pascal, Jean‐Pierre Joffre, Francis Vinel, Jean‐Pierre |
| description | The optimal management of ruptured gastric varices in patients with cirrhosis has not been codified yet. The present study reports the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory gastric variceal bleeding. Thirty‐two consecutive patients were included. All had been unresponsive to vasoactive agents infusion, sclerotherapy, and/or tamponade and were considered poor surgical candidates. They were followed‐up until death, transplantation, or at least 1 year (median: 509 days; range 4 to 2,230). Hemostasis was achieved in 18 out of 20 patients actively bleeding at the time of the procedure. In the whole sample of 32 patients, rebleeding rates were 14%, 26%, and 31%, respectively at 1 month, 6 months, and 1 year. De novo encephalopathy was observed in 5 (16%) patients. Seven patients experienced complications and consequently 4 of these patients died. TIPS primary patency rates were 84%, 74%, and 51%, respectively, at 1 month, 6 months, and 1 year. For the same periods of time, survival rates were 75%, 62%, and 59%. These results suggest that TIPS can be used in cirrhotic patients with refractory gastric variceal bleeding and are effective in achieving hemostasis as well as in preventing rebleeding. |
| doi_str_mv | 10.1002/hep.510300523 |
| format | Article |
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The present study reports the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory gastric variceal bleeding. Thirty‐two consecutive patients were included. All had been unresponsive to vasoactive agents infusion, sclerotherapy, and/or tamponade and were considered poor surgical candidates. They were followed‐up until death, transplantation, or at least 1 year (median: 509 days; range 4 to 2,230). Hemostasis was achieved in 18 out of 20 patients actively bleeding at the time of the procedure. In the whole sample of 32 patients, rebleeding rates were 14%, 26%, and 31%, respectively at 1 month, 6 months, and 1 year. De novo encephalopathy was observed in 5 (16%) patients. Seven patients experienced complications and consequently 4 of these patients died. TIPS primary patency rates were 84%, 74%, and 51%, respectively, at 1 month, 6 months, and 1 year. For the same periods of time, survival rates were 75%, 62%, and 59%. These results suggest that TIPS can be used in cirrhotic patients with refractory gastric variceal bleeding and are effective in achieving hemostasis as well as in preventing rebleeding.</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.510300523</identifier><identifier>PMID: 10534333</identifier><identifier>CODEN: HPTLD9</identifier><language>eng</language><publisher>Philadelphia, PA: W.B. Saunders</publisher><subject>Actuarial Analysis ; Biological and medical sciences ; Cause of Death ; Esophageal and Gastric Varices - complications ; Esophageal and Gastric Varices - mortality ; Esophageal and Gastric Varices - surgery ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage - etiology ; Gastrointestinal Hemorrhage - mortality ; Gastrointestinal Hemorrhage - surgery ; Humans ; Liver Cirrhosis - complications ; Liver, biliary tract, pancreas, portal circulation, spleen ; Male ; Medical sciences ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic ; Postoperative Complications ; Retrospective Studies ; Rupture, Spontaneous ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Survival Analysis</subject><ispartof>Hepatology (Baltimore, Md.), 1999-11, Vol.30 (5), p.1139-1143</ispartof><rights>Copyright © 1999 American Association for the Study of Liver Diseases</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4713-bdc1c7c74ad6f09c1c8d72e17b543491204d66a9aeca30e563fb54b3e06b61423</citedby><cites>FETCH-LOGICAL-c4713-bdc1c7c74ad6f09c1c8d72e17b543491204d66a9aeca30e563fb54b3e06b61423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhep.510300523$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhep.510300523$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1993136$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10534333$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barange, Karl</creatorcontrib><creatorcontrib>Péron, Jean‐Marie</creatorcontrib><creatorcontrib>Imani, Kamran</creatorcontrib><creatorcontrib>Otal, Philippe</creatorcontrib><creatorcontrib>Payen, Jean‐Louis</creatorcontrib><creatorcontrib>Rousseau, Herve</creatorcontrib><creatorcontrib>Pascal, Jean‐Pierre</creatorcontrib><creatorcontrib>Joffre, Francis</creatorcontrib><creatorcontrib>Vinel, Jean‐Pierre</creatorcontrib><title>Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices</title><title>Hepatology (Baltimore, Md.)</title><addtitle>Hepatology</addtitle><description>The optimal management of ruptured gastric varices in patients with cirrhosis has not been codified yet. The present study reports the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory gastric variceal bleeding. Thirty‐two consecutive patients were included. All had been unresponsive to vasoactive agents infusion, sclerotherapy, and/or tamponade and were considered poor surgical candidates. They were followed‐up until death, transplantation, or at least 1 year (median: 509 days; range 4 to 2,230). Hemostasis was achieved in 18 out of 20 patients actively bleeding at the time of the procedure. In the whole sample of 32 patients, rebleeding rates were 14%, 26%, and 31%, respectively at 1 month, 6 months, and 1 year. De novo encephalopathy was observed in 5 (16%) patients. Seven patients experienced complications and consequently 4 of these patients died. TIPS primary patency rates were 84%, 74%, and 51%, respectively, at 1 month, 6 months, and 1 year. For the same periods of time, survival rates were 75%, 62%, and 59%. These results suggest that TIPS can be used in cirrhotic patients with refractory gastric variceal bleeding and are effective in achieving hemostasis as well as in preventing rebleeding.</description><subject>Actuarial Analysis</subject><subject>Biological and medical sciences</subject><subject>Cause of Death</subject><subject>Esophageal and Gastric Varices - complications</subject><subject>Esophageal and Gastric Varices - mortality</subject><subject>Esophageal and Gastric Varices - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Gastrointestinal Hemorrhage - surgery</subject><subject>Humans</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Portasystemic Shunt, Transjugular Intrahepatic</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Rupture, Spontaneous</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Survival Analysis</subject><issn>0270-9139</issn><issn>1527-3350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1v1DAQhi0EotvCkSvyAfWWduxJ7PqIqtIiVaKHco4cZ7KbKl94HND-e1ztquXExdZ4Hr3jeYT4pOBCAejLHS0XlQIEqDS-ERtVaVsgVvBWbEBbKJxCdyJOmZ8AwJX66r04UVBhiYgbwY_RT_y0btfBR9lPKfqc6FMf5DLHNPOeE4254t06pQzItCOZIvk0Un6YOxmpiz6kOe5lMxC1_bSVXZxHGdclrZFaufWcYs747fNJ_EG86_zA9PF4n4mf324er--K-x-336-_3hehtAqLpg0q2GBL35oOXC6uWqtJ2aYqsXRKQ9ka452n4BGoMtjlToMEpjGq1Hgmzg-5S5x_rcSpHnsONAx-onnl2jitDNpnsDiAIc7MeZ96if3o475WUD9brrOT-sVy5j8fg9dmpPYf-qA1A1-OgOfgh-xnCj2_cs6hQpMxe8D-9APt_z-0vrt5eP3BX-VMl-Q</recordid><startdate>199911</startdate><enddate>199911</enddate><creator>Barange, Karl</creator><creator>Péron, Jean‐Marie</creator><creator>Imani, Kamran</creator><creator>Otal, Philippe</creator><creator>Payen, Jean‐Louis</creator><creator>Rousseau, Herve</creator><creator>Pascal, Jean‐Pierre</creator><creator>Joffre, Francis</creator><creator>Vinel, Jean‐Pierre</creator><general>W.B. 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Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barange, Karl</creatorcontrib><creatorcontrib>Péron, Jean‐Marie</creatorcontrib><creatorcontrib>Imani, Kamran</creatorcontrib><creatorcontrib>Otal, Philippe</creatorcontrib><creatorcontrib>Payen, Jean‐Louis</creatorcontrib><creatorcontrib>Rousseau, Herve</creatorcontrib><creatorcontrib>Pascal, Jean‐Pierre</creatorcontrib><creatorcontrib>Joffre, Francis</creatorcontrib><creatorcontrib>Vinel, Jean‐Pierre</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barange, Karl</au><au>Péron, Jean‐Marie</au><au>Imani, Kamran</au><au>Otal, Philippe</au><au>Payen, Jean‐Louis</au><au>Rousseau, Herve</au><au>Pascal, Jean‐Pierre</au><au>Joffre, Francis</au><au>Vinel, Jean‐Pierre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices</atitle><jtitle>Hepatology (Baltimore, Md.)</jtitle><addtitle>Hepatology</addtitle><date>1999-11</date><risdate>1999</risdate><volume>30</volume><issue>5</issue><spage>1139</spage><epage>1143</epage><pages>1139-1143</pages><issn>0270-9139</issn><eissn>1527-3350</eissn><coden>HPTLD9</coden><abstract>The optimal management of ruptured gastric varices in patients with cirrhosis has not been codified yet. The present study reports the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory gastric variceal bleeding. Thirty‐two consecutive patients were included. All had been unresponsive to vasoactive agents infusion, sclerotherapy, and/or tamponade and were considered poor surgical candidates. They were followed‐up until death, transplantation, or at least 1 year (median: 509 days; range 4 to 2,230). Hemostasis was achieved in 18 out of 20 patients actively bleeding at the time of the procedure. In the whole sample of 32 patients, rebleeding rates were 14%, 26%, and 31%, respectively at 1 month, 6 months, and 1 year. De novo encephalopathy was observed in 5 (16%) patients. Seven patients experienced complications and consequently 4 of these patients died. TIPS primary patency rates were 84%, 74%, and 51%, respectively, at 1 month, 6 months, and 1 year. For the same periods of time, survival rates were 75%, 62%, and 59%. These results suggest that TIPS can be used in cirrhotic patients with refractory gastric variceal bleeding and are effective in achieving hemostasis as well as in preventing rebleeding.</abstract><cop>Philadelphia, PA</cop><pub>W.B. Saunders</pub><pmid>10534333</pmid><doi>10.1002/hep.510300523</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Actuarial Analysis Biological and medical sciences Cause of Death Esophageal and Gastric Varices - complications Esophageal and Gastric Varices - mortality Esophageal and Gastric Varices - surgery Female Follow-Up Studies Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - mortality Gastrointestinal Hemorrhage - surgery Humans Liver Cirrhosis - complications Liver, biliary tract, pancreas, portal circulation, spleen Male Medical sciences Middle Aged Portasystemic Shunt, Transjugular Intrahepatic Postoperative Complications Retrospective Studies Rupture, Spontaneous Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Survival Analysis |
| title | Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices |
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