Transjugular intrahepatic portosystemic shunt (TIPS) is considered the standard of care in patients with emergent variceal bleeding—bleeding of varices in the gastrointestinal tract typically caused by liver disease.
However, a retrospective study showed that the less common IR procedure percutaneous transhepatic variceal embolization (PTVE) was effective in emergent cases that were contraindicated for TIPS.
The featured abstract “Comparative Study of Percutaneous Transhepatic Variceal Embolization versus Transjugular Intrahepatic Portosystemic Shunt in Controlling Emergent Variceal Hemorrhage” will be presented by Jacob Byers, a third-year medical student at the University of Cincinnati (UC), during Monday’s Scientific Session 13, GI Interventions, from 3–4:30 p.m. MT.
The UC research team conducted the study under the leadership of Ali Kord, MD, MPH, an IR and assistant professor of clinical radiology. Byers explained the impetus of the study: Dr. Kord was speaking with another UC attending who said he found PTVE to be a good option in cases in which a patient is very unstable or has altered anatomy. PTVE was considered to be faster than TIPS, which was important for patients who had needed a massive blood transfusion, or had hemodynamic instability or shock, Byers said.
“Because TIPS is the gold standard for these patients, we wanted to see if this other option is noninferior because it can typically be done more quickly; it’s a less-involved procedure,” Byers said. “So if you’re at a smaller community hospital, or you’re someone who doesn’t have a lot of experience doing TIPS, the thought was that at least you could stabilize the patient with a percutaneous embolization for the moment. Then a lot of times the patients will still need TIPS down the road.”
The research team conducted a single-center retrospective study, looking at charts for patients who received PTVE or TIPS to control emergent variceal bleeding during 2002–2023. Technical success was compared between the two groups, and the primary outcome was rebleeding rates.
The study included 333 patients: 10 had an emergent PTVE and 40 underwent TIPS. The technical success rate was 100% in both groups. The rebleeding rates at 5 days, 1 month, 6 months and 1 year were not significantly different between the two groups. There was also no significant difference in survival rate between the two groups at 1 month, 3 months and 6 months.
Byers pointed out that their study looked at emergent cases, while much of the previous literature has looked at elective cases identified on imaging where patients were not currently bleeding out or hemodynamically unstable. The new research gives direct support to TIPS use in emergency cases, where previously operators were relying on the evidence from elective cases.
