Comparison of transjugular intrahepatic portosystemic with endoscopic treatment plus anticoagulation for esophageal variceal bleeding and portal vein thrombosis in liver cirrhosis

Abstract

Background and aim

The optimal management of esophageal variceal bleeding (EVB) and portal vein thrombosis (PVT) in liver cirrhosis has not been well-established. The aim of the present study was to compare the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic treatment (ET) plus anticoagulation in cirrhotic patients with EVB and PVT.

Patients and methods

A total of 66 cirrhotic patients with PVT and EVB (31 in the TIPS group and 35 in the ET plus anticoagulation group) were evaluated retrospectively between January 2016 and January 2022.

Results

During the follow-up period, 85.5% of patients in the TIPS group achieved complete recanalization of the portal vein, as compared with 19.6% in the ET plus anticoagulation group (p < .001). The cumulative 5-year rate of variceal rebleeding in the TIPS group was significantly lower than that in the ET plus anticoagulation group (31.0 vs. 50.1%; p = .017). The TIPS group exhibited a significantly higher incidence of overt hepatic encephalopathy (HE) than the ET plus anticoagulation group (25.8 vs. 5.7%; p = .037). No difference in the 5-year survival rate (74.1 vs. 85.7%; p = .692) and probability of other complications was observed between the two groups.

Conclusion

TIPS was superior to ET plus anticoagulation in preventing variceal rebleeding and achieving recanalization of PVT but increased the incidence of overt HE without improving the survival rate.

Keywords:

• Esophageal variceal bleeding
• portal vein thrombosis
• transjugular intrahepatic portosystemic shunt
• anticoagulation
• endoscopic variceal ligation
• endoscopic injection sclerotherapy

Acknowledgment

The authors thank Mingquan Wang, Guobing Zhang and all the staff at the Department of Gastroenterology and Department of Intervention Therapy for the their contribution to this work.

Informed consent statement

Informed written consent was obtained from patient prior to the publication of the present report and any accompanying images.

Disclosure statement

The authors declare that they have no conflicts of interest.

Additional information

Funding

The present study was supported by the sixth batch of appropriate technology for health promotion project of Anhui Provincial Health Commission [SYJS202103]. The funders had no input in the study design, data collection and analysis, decision to publish or preparation of the manuscript.