Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2023; 29(22): 3519-3533
Published online Jun 14, 2023. doi: 10.3748/wjg.v29.i22.3519
Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application: A comparison study
Xi-Xuan Wang, Xiao-Chun Yin, Li-Hong Gu, Hui-Wen Guo, Yang Cheng, Yan Liu, Jiang-Qiang Xiao, Yi Wang, Wei Zhang, Xiao-Ping Zou, Lei Wang, Ming Zhang, Yu-Zheng Zhu-Ge, Feng Zhang
Xi-Xuan Wang, Xiao-Chun Yin, Li-Hong Gu, Yang Cheng, Yan Liu, Jiang-Qiang Xiao, Yi Wang, Wei Zhang, Xiao-Ping Zou, Lei Wang, Ming Zhang, Yu-Zheng Zhu-Ge, Feng Zhang, Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China
Xi-Xuan Wang, Yu-Zheng Zhu-Ge, Medical School, Southeast University, Nanjing 210000, Jiangsu Province, China
Hui-Wen Guo, Department of Gastroenterology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
Author contributions: Wang XX and Yin XC contributed equally to this work; Zhang F, Zhu-Ge YZ, Wang XX contributed to the conceptualization; Wang XX, Yin XC, Gu LH, Guo HW, Cheng Y, Liu Y contributed to the data curation; Zhang F, Zhu-Ge YZ, Wang XX contributed to the formal analysis; Zhang F acquired the funding; Wang XX, Yin XC, Gu LH, Guo HW, Cheng Y, Liu Y contributed to the investigation; Zhang F, Zhu-Ge YZ, Zhang M, Xiao JQ, Wang Y, Zhang W contributed to the methodology; Zhang F, Zhu-Ge YZ, Zhang M administered the project; Wang L, Zou XP contributed to the resources; Wang L, Zou XP utilized the software; Zhang F, Zhu-Ge YZ, Zhang M contributed to the supervision; Wang XX, Yin XC, Gu LH, Guo HW contributed to the validation; Wang XX, Yin XC contributed to the visualization; Wang XX wrote the original draft; Zhang F, Zhu-Ge YZ reviewed and edited the draft; all authors have read and approve the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81900552; Nanjing Health Science, Technology Development Special Fund Project-Key project, No. ZKX19015; Outstanding Youth Fund project, No. JQX20005; Funding for Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University, No. 2022-LCYJ-MS-13.
Institutional review board statement: The study was reviewed and approved for publication by our institutional (Nanjing Drum Tower Hospital) reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent for personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: No authors have conflicts of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available upon request from the corresponding author at fzdndx@126.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Zhang, MD, Doctor, Professor, Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210000, Jiangsu Province, China. fzdndx@126.com
Received: January 3, 2023
Peer-review started: January 3, 2023
First decision: March 8, 2023
Revised: March 15, 2023
Accepted: May 17, 2023
Article in press: May 17, 2023
Published online: June 14, 2023
ARTICLE HIGHLIGHTS
Research background

It is controversial whether transjugular intrahepatic portosystemic shunt (TIPS) placement can improve long-term survival.

Research motivation

To clarify the feasibility of hepatic venous pressure gradient (HVPG) as a risk stratification strategy for patients with decompensated cirrhosis.

Research objectives

To assess whether TIPS placement improves survival in patients with HVPG ≥ 16 mmHg based on HVPG-related risk stratification.

Research methods

Consecutive variceal bleeding patients treated with endoscopic variceal ligation (EVL) + nonselective β-blockers (NSBBs) or covered TIPS placement were retrospectively enrolled between January 2013 and December 2019. HVPG measurements were performed before therapy. The primary outcome was transplant-free survival; secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE).

Research results

A total of 184 patients were analyzed (mean age, 55.27 years ± 13.86, 107 males; 102 in the EVL+NSBB group, 82 in the covered TIPS group). Based on the HVPG-guided risk stratification, 70 patients had HVPG < 16 mmHg, and 114 patients had HVPG ≥ 16 mmHg. The median follow-up time of the cohort was 49.5 mo. There was no significant difference in transplant-free survival between the two treatment groups overall (hazard ratio [HR], 0.61; 95% confidence interval [CI]: 0.35-1.05; P = 0.07). In the high-HVPG tier, transplant-free survival was higher in the TIPS group (HR, 0.44; 95%CI: 0.23, 0.85; P = 0.004). In the low-HVPG tier, transplant-free survival after the two treatments was similar (HR, 0.86; 95%CI: 0.33, 0.23; P = 0.74). Covered TIPS placement decreased the rate of rebleeding independent of the HVPG tier (P < 0.001). The difference in OHE between the two groups was not statistically significant (P = 0.09; P = 0.48).

Research conclusions

TIPS placement can effectively improve transplant-free survival when the HVPG is greater.

Research perspectives

Further randomized controlled trials need to be performed to prove the benefit of covered TIPS placement in the secondary prevention of decompensated cirrhosis.