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. 2020 Aug 17;3(4):195-200.
doi: 10.1016/j.jimed.2020.08.008. eCollection 2020 Dec.

Comparison of embolic agents for varices during transjugular intrahepatic portosystemic shunt for variceal bleeding: Tissue gel or coil?

Linfeng Zhou  1   2 , Binyan Zhong  1 , Hang Du  1 , Wansheng Wang  1 , Jian Shen  1 , Shuai Zhang  1 , Wanci Li  1 , Haohuan Tang  1 , Peng Zhang  1 , Weihao Yang  1 , Xiaoli Zhu  1
Affiliations

Comparison of embolic agents for varices during transjugular intrahepatic portosystemic shunt for variceal bleeding: Tissue gel or coil?

Linfeng Zhou et al. J Interv Med. .

Abstract

Purpose: We aimed to compare treatment efficacy, safety and material cost between tissue gel and coil regarding variceal embolization during transjugular intrahepatic portosystemic shunt (TIPS).Materials & Methods: This retrospective study including cirrhotic patients with variceal bleeding treated with TIPS combined with variceal embolization between January 2016 and August 2017. Patients were divided into three groups according to embolic agents used in variceal embolization: tissue gel group (Group A), combination group (Group B), and coil group (Group C). The primary endpoint was 1-year rebleeding rate after TIPS creation. The secondary endpoints included shunt dysfunction, overt hepatic encephalopathy, liver function, and embolic agents-related expense.

Results: A total of 60 patients (30, 10, and 20 in Group A, B, and C) were included. Variceal rebleeding occurred in 3 (10%), 0 (0%), and 4 (20%) patients within one year after TIPS creation in Group A, B, and C, respectively. Stent dysfunction occurred in 2 (3.3%) patients and 9 (15.0%) patients experienced overt hepatic encephalopathy. No significant differences were observed between three groups regarding primary and secondary endpoints except embolic agents-related expense, with a significantly lower cost in Group A when compared to the other two groups. Stent dysfunction occurred in two patients, with one patient in Group A developed acute occlusion caused by thrombus and another patient in Group C underwent stent stenosis during follow-up.

Conclusions: Compares to coil alone or combines with coil, tissue gel has similar treatment efficacy and safety, but with significantly lower cost for variceal bleeding during TIPS.

Keywords: Embolotherapy; Esophageal and gastric varices; Transjugular intrahepatic portasystemic shunt.

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Conflict of interest statement

The authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.

Figures

Fig. 1
Fig. 1
Procedure of TIPS creation. Pre-procedure (A, C, and E) and post-procedure (B, D, and F) venography in patients who underwent embolization with tissue gel (A, B), tissue gel combined with coil (C, D), and coil (E, F).
Fig. 2
Fig. 2
Study flowchart.
Fig. 3
Fig. 3
Embolic agent-related expense in the tissue gel, combination, and coil groups. After the Kruskal-Wallis test, the tissue gel group showed a significant lower cost than the coil group (P ​< ​0.001) and the tissue gel combined with coil group (P ​< ​0.001).
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