Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

Abstract

Background and aims: The transjugular intrahepatic portosystemic shunt (TIPS) is a new therapeutic modality for variceal bleeding. In this study we compared the two year survival and rebleeding rates in cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding.

Methods: Eighty cirrhotic patients (Pugh score 7-12) with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding.

Results: Mean follow up was 581 days in the ligation group and 678 days in the TIPS group. The two year survival rate was 57% in the TIPS group and 56% in the ligation group (NS); the incidence of variceal rebleeding after two years was 18% in the TIPS group and 66% in the ligation group (p<0.001). Uncontrolled rebleeding occurred in 11 patients in the ligation group (eight were rescued by emergency TIPS) but in none of the TIPS group. The incidence of encephalopathy at two years was 47% in the TIPS group and 44% in the ligation group (NS).

Conclusions: TIPS did not increase the two year survival rate compared with variceal band ligation after variceal bleeding in cirrhotic patients with moderate or severe liver failure. It significantly reduced the incidence of variceal rebleeding without increasing the rate of encephalopathy.

Figure 1

Cumulative proportion of patients surviving (Kaplan-Meier plot) in the ligation and transjugular intrahepatic portosystemic shunt (TIPS) groups.

Figure 2

Cumulative proportion of patients free of variceal bleeding (Kaplan-Meier plot) in the ligation and transjugular intrahepatic portosystemic shunt (TIPS) groups.

Figure 3

Cumulative proportion of patients free of hepatic encephalopathy (Kaplan-Meier plot) in the ligation and transjugular intrahepatic portosystemic shunt (TIPS) groups.