Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2025; 17(6): 105578
Published online Jun 27, 2025. doi: 10.4254/wjh.v17.i6.105578
Long-term outcomes of early transjugular intrahepatic portosystemic shunts in patients with acute variceal bleeding and cirrhosis
Xin Tang, Ju-Bo Liang, Chen Wang, Jia-Li Ma, Rong-Rong Jia, Yu-Gang Wang, Min Shi
Xin Tang, Chen Wang, Jia-Li Ma, Rong-Rong Jia, Yu-Gang Wang, Min Shi, Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
Xin Tang, Chen Wang, Jia-Li Ma, Rong-Rong Jia, Yu-Gang Wang, Min Shi, Key Laboratory for Translational Research and Innovative Therapeutics of Gastrointestinal Oncology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
Ju-Bo Liang, Department of Digestive Diseases, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha 410000, Hunan Province, China
Co-first authors: Xin Tang and Ju-Bo Liang.
Co-corresponding authors: Yu-Gang Wang and Min Shi.
Author contributions: Tang X wrote the original draft; Tang X and Liang JB contributed equally to this article, they are the co-first authors of this manuscript; Liang JB and Wang C participated in the formal analysis and investigation; Ma JL and Jia RR were responsible for developing the methodology; Shi M and Wang YG designed the study and acquired funding, they contributed equally to this article, they are the co-corresponding authors of this manuscript; Tang X, Wang YG, and Shi M participated in the review and editing; and all authors have read and approve the final manuscript.
Supported by the Natural Science Foundation of the Science and Technology Commission of Shanghai Municipality, No. 23ZR1458300; the Key Discipline Project of Shanghai Municipal Health System, No. 2024ZDXK0004; and the Doctoral Innovation Talent Base Project for Diagnosis and Treatment of Chronic Liver Diseases, No. RCJD2021B02.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Tongren Hospital, Shanghai Jiao Tong University School of Medicine, approval No. K2024-067-01.
Informed consent statement: Signed informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Shi, MD, Professor, Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai 200336, China. sm1790@shtrhospital.com
Received: February 17, 2025
Revised: April 12, 2025
Accepted: May 16, 2025
Published online: June 27, 2025
Processing time: 130 Days and 22.7 Hours
Abstract
BACKGROUND

Early transjugular intrahepatic portosystemic shunts (TIPS) is a therapeutic option for acute variceal bleeding (AVB), offering a low risk of rebleeding. However, the long-term outcomes of early TIPS remain unclear.

AIM

To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.

METHODS

We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023. The primary outcome was overall survival (OS).

RESULTS

A total of 37 patients with AVB underwent early TIPS, while 65 patients received standard treatment. Compared with the standard treatment group, the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower (10.8% vs 50.8%, P < 0.001). Over a median follow-up of 46 months, no statistically significant differences were observed in terms of OS (P = 0.507). The presence of comorbidities was identified as an independent predictor of OS (adjusted hazard ratio = 3.81; 95% confidence interval: 1.16-12.46). Notably, new or worsening ascites occurred less frequently in the early TIPS group (13.5% vs 38.5%, P = 0.008). There was no significant difference in the rate of overt hepatic encephalopathy between the two groups (45.9% vs 36.9%, P = 0.372).

CONCLUSION

While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB, it is associated with reduced risks of rebleeding and ascites.

Keywords: Early transjugular intrahepatic portosystemic shunt; Long-term outcome; Acute variceal bleeding; Cirrhosis; Comorbidities

Core Tip: The long-term outcomes of early transjugular intrahepatic portosystemic shunts (TIPS) for acute variceal bleeding (AVB) remain unclear. This retrospective cohort study analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment. We found that early TIPS was associated with a lower risk of rebleeding and ascites compared with standard treatment for AVB; however, long-term survival did not improve. Moreover, we identified the presence of comorbidities was associated with survival for AVB.