Clinical efficacy of surgically assisted transjugular intrahepatic portosystemic shunt for cavernous transformation of portal vein.

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is contraindicated for patients with cavernous transformation of the portal vein (CTPV) due to high surgery-related mortality risk. However, surgically assisted TIPS (SATIPS) can significantly reduce the risk.

AIM: To evaluate the clinical efficacy of SATIPS, this study was conducted.

METHODS

One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals. Overall, 54 patients received SATIPS treatment (SATIPS group), while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation (control group). Subsequently, survival rates, incidence rates of gastrointestinal bleeding, incidence of hepatic encephalopathy rate, and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.

RESULTS

The survival rates for the SATIPS and control groups were 94.4% and 92.5% at 3 months (P value = 0.72) and 94.4% and 73.6% at 6 months (P value = 0.0051) respectively. The incidence of liver failure was 3.7% and 9.4% at 3 months (P value = 0.26) and 3.7% and18.9% at 6 months (P value = 0.016); the incidence of gastrointestinal bleeding was 5.6% and 37.7% at 3 months (P value < 0.001) and 9.3% and 47.2% (P value < 0.001) at 6 months; and the incidence of hepatic encephalopathy was 3.7% and 17.0% at 3 months (P value = 0.026) and 7.4% and 26.4% at 6 months (P value = 0.026) respectively.

CONCLUSION

For patients with CTPV, there were no optimal treatment. Regarding long-term efficacy, SATIPS can significantly reduce the rate of rebleeding, hepatic encephalopathy and liver failure, and is associated with better survival.