1. Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding
- Author
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Marika Rudler, Virginia Hernández-Gea, Bogdan Dumitru Procopet, Alvaro Giráldez, Lucio Amitrano, Càndid Villanueva, Luis Ibañez, Gilberto Silva-Junior, Joan Genesca, Christophe Bureau, Jonel Trebicka, Rafael Bañares, Aleksander Krag, Elba Llop, Wim Laleman, Jose Maria Palazon, Jose Castellote, Susana Rodrigues, Lise Lotte Gluud, Carlos Noronha Ferreira, Nouria Canete, Manuel Rodríguez, Arnulf Ferlitsch, Jose Luis Mundi, Henning Gronbaek, Manuel Hernandez-Guerra, Romano Sassatelli, Alessandra Dell’era, Marco Senzolo, Juan G Abraldes, Manuel Romero-Gómez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Hélène Larrue, Massimo Primignani, Frederik Nevens, Jose Luis Calleja, Remy Schwarzer, Christian Jansen, Marie-Angèle Robic, Irene Conejo, Javier Martínez Gonzalez, Maria Vega Catalina, Agustín Albillos, Edilmar Alvarado, Maria Anna Guardascione, Maxime Mallet, Simona Tripon, Georgina Casanovas, Jaume Bosch, Juan-Carlos Garcia-Pagan, and Dominique Thabut
- Subjects
End Stage Liver Disease ,Liver Cirrhosis/complications ,Hepatic Encephalopathy/etiology ,Esophageal and Gastric Varices/complications ,Contraindications ,cirrhosis ,oesophageal varices ,hepatic encephalopathy ,Gastroenterology ,Humans ,610 Medizin und Gesundheit ,Severity of Illness Index ,Gastrointestinal Hemorrhage/etiology - Abstract
BackgroundA pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that Patients and methodsThis is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation.Results671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients.ConclusionpTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.
- Published
- 2022
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