Document Detail


Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis.
MedLine Citation:
PMID:  11690704     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/AIMS: The place of transjugular intrahepatic porto-systemic shunt (TIPS) for variceal haemorrhage uncontrolled by sclerotherapy and medical treatment is still undefined. To investigate the outcome of early salvage TIPS for active uncontrolled variceal haemorrhage, and to identify the factors associated with mortality. METHODS: Salvage TIPS was performed in 58 patients as soon as possible after the diagnosis of variceal bleeding refractory to the combination of sclerotherapy and of pharmacological therapy. Twenty-three variables were assessed prospectively to identify predictors of mortality within 60 days of the procedure. RESULTS: The haemorrhage was controlled in 52 of 58 patients (90%). Bleeding persisted in six of 58 patients (10%), and recurred in four patients (7%). Overall, 17 (29%) and 20 (35%) patients died within respectively 30 days and 60 days of TIPS: five patients died of persistent bleeding, two patients died of recurrent bleeding, and 13 patients died of terminal liver failure. The actuarial survival following salvage TIPS was 51.7% at 1 year. On multivariate analysis, independent predictors of early mortality were: the presence of sepsis (P=0.001), the use of catecholamines for systemic hemodynamic impairment (P=0.009), and the use of balloon tamponade (P=0.04). Neither a single factor, nor a combination of factors before TIPS allowed to predict mortality confidently in a given patient. CONCLUSIONS: Early salvage TIPS is an effective treatment to stop active variceal bleeding refractory to sclerotherapy and pharmacological treatment. Pre-treatment prognostic determinants that correlate to mortality can not be used to predict the outcome in individual cases.
Authors:
D Azoulay; D Castaing; P Majno; F Saliba; P Ichaï; A Smail; V Delvart; M Danaoui; D Samuel; H Bismuth
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of hepatology     Volume:  35     ISSN:  0168-8278     ISO Abbreviation:  J. Hepatol.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-11-05     Completed Date:  2002-02-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  590-7     Citation Subset:  IM    
Affiliation:
Department of Liver Surgery and Liver Transplantation, Centre Hépato-Biliaire, UPRES No 1596, IFR 89.9, Hôpital Paul Brousse, Villejuif, France. daniel.azoulay@pbr.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Bilirubin / blood
Blood Transfusion
Esophageal and Gastric Varices / etiology,  mortality,  therapy*
Female
Follow-Up Studies
Humans
Liver Cirrhosis / complications*
Liver Cirrhosis, Alcoholic / complications
Male
Middle Aged
Portasystemic Shunt, Transjugular Intrahepatic*
Recurrence
Sclerotherapy
Survival Analysis
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
635-65-4/Bilirubin
Comments/Corrections
Comment In:
J Hepatol. 2002 Nov;37(5):703-4   [PMID:  12399244 ]
J Hepatol. 2001 Nov;35(5):658-60   [PMID:  11690713 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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