Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Transjugular intrahepatic portosystemic shunt and splenectomy are more effective than endoscopic therapy for recurrent variceal bleeding in patients with idiopathic noncirrhotic portal hypertension
Fu-Liang He, Rui-Zhao Qi, Yue-Ning Zhang, Ke Zhang, Yu-Zheng Zhu-Ge, Min Wang, Yu Wang, Ji-Dong Jia, Fu-Quan Liu
Fu-Liang He, Min Wang, Yu Wang, Ji-Dong Jia, Department of Hepatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Rui-Zhao Qi, Department of General Surgery, Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Yue-Ning Zhang, Department of Gastroenterology, Beijing You’an Hospital, Capital Medical University, Beijing 100069, China
Ke Zhang, Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
Yu-Zheng Zhu-Ge, Department of Gastroenterology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Author contributions: He FL, Qi RZ, Zhang YN, Zhang K, Wang M and Wang Y designed the research; He FL and Qi RZ performed the research; He FL, Wang M and Zhu-Ge YZ analyzed the data; and Zhu-Ge YZ, Jia JD and Liu FQ supervised the study.
Supported by Beijing Hospitals Authority Youth Program, No. 20180701.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Beijing Shijitan Hospital, Capital Medical University.
Informed consent statement: All patients signed informed consent to the study.
Conflict-of-interest statement: We have no conflict-of-interest to disclose.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, MD, Doctor, Professor, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Road, Beijing 100038, China. liufq_sjt@163.com
Received: February 4, 2020
Peer-review started: February 4, 2020
First decision: March 18, 2020
Revised: March 28, 2020
Accepted: April 15, 2020
Article in press: April 15, 2020
Published online: May 26, 2020
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS), splenectomy plus esophagogastric devascularization (SED) and endoscopic therapy + non-selective β-blockers (ET + NSBB) are widely applied in secondary prevention of recurrent gastroesophageal variceal bleeding in patients with liver cirrhosis. These different treatments, however, have not been compared in patients with idiopathic non-cirrhotic portal hypertension (INCPH).
AIM
To compare the outcomes of TIPS, SED and ET + NSBB in the control of variceal rebleeding in patients with INCPH.
METHODS
This retrospective study recruited patients from six centers across China. Demographic characteristics, baseline profiles and follow-up clinical outcomes were collected. Post-procedural clinical outcomes, including incidence of rebleeding, hepatic encephalopathy (HE), portal vein thrombosis (PVT) and mortality rates, were compared in the different groups.
RESULTS
In total, 81 patients were recruited, with 28 receiving TIPS, 26 SED, and 27 ET + NSBB. No significant differences in demographic and baseline characteristics were found among these three groups before the procedures. After treatment, blood ammonia was significantly higher in the TIPS group; hemoglobin level and platelet count were significantly higher in the SED group (P < 0.01). Rebleeding rate was significantly higher in the ET + NSBB group (P < 0.01). Mortality was 3.6%, 3.8% and 14.8% in the TIPS, SED and ET + NSBB groups, respectively, with no significant differences (P = 0.082). Logistic regression analysis showed that mortality was significantly correlated with rebleeding, HE, portal thrombosis and superior mesenteric vein thrombosis (P < 0.05).
CONCLUSION
In patients with INCPH, TIPS and SED were more effective in controlling rebleeding than ET + NSBB, but survival rates were not significantly different among the three groups. Mortality was significantly correlated with rebleeding, HE and PVT.
Core tip: This is the first study to compare outcomes of transjugular intrahepatic portosystemic shunt, splenectomy plus esophagogastric devascularization and endoscopic therapy plus non-selective β-blockers in the control of recurrent variceal bleeding in patients with idiopathic non-cirrhotic portal hypertension.
