Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Hernández-Gea Virginia, Procopet Bogdan, Giráldez Álvaro, Amitrano Lucio, Villanueva Candid, Thabut Dominique, Ibañez-Samaniego Luis, Silva-Junior Gilberto, Martinez Javier, Genescà Joan, Bureau Christophe, Trebicka Jonel, Llop Elba, Laleman Wim, Palazon Jose Maria, Castellote Jose, Rodrigues Susana, Gluud Lise L, Noronha Ferreira Carlos, Barcelo Rafael, Cañete Nuria, Rodríguez Manuel, Ferlitsch Arnulf, Mundi Jose Luis, Gronbaek Henning, Hernández-Guerra Manuel, Sassatelli Romano, Dell'Era Alessandra, Senzolo Marco, Abraldes Juan G, Romero-Gómez Manuel, Zipprich Alexander, Casas Meritxell, Masnou Helena, Primignani Massimo, Krag Aleksander, Nevens Frederik, Calleja Jose Luis, Jansen Christian, Robic Marie Angèle, Conejo Irene, Catalina Maria-Vega, Albillos Agustin, Rudler Marika, Alvarado Edilmar, Guardascione Maria Anna, Tantau Marcel, Bosch Jaime, Torres Ferran, Garcia-Pagán Juan Carlos, International Variceal Bleeding Observational Study Group and Baveno Cooperation
Аннотация
Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.