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. 2024 Feb 3;10(3):e25824.
doi: 10.1016/j.heliyon.2024.e25824. eCollection 2024 Feb 15.

The time window for pre-emptive transjugular intrahepatic portosystemic shunt could be extended to 5 days

Xiangjun Dong  1   2 , Jiacheng Liu  1   2 , Yaowei Bai  1   2 , Xiaoming Liu  1   2 , Jinqiang Ma  1   2 , Binqian Zhou  3 , Yanqiao Ren  1   2 , Chuansheng Zheng  1   2
Affiliations

The time window for pre-emptive transjugular intrahepatic portosystemic shunt could be extended to 5 days

Xiangjun Dong et al. Heliyon. .

Abstract

As recommended by Baveno VII consensus, the utilization of pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) has been considered as standard therapeutic approach for the management of acute variceal bleeding (AVB) associated with cirrhosis., but the 72-h window for pTIPS is too narrow. This study aimed to compare the clinical outcomes between patients who received <72 h pTIPS and 72 h-5d pTIPS. In this study, a total of 63 cirrhotic patients with AVB who underwent pTIPS between October 2016 and December 2021 were included in this retrospective study. They were divided into <72 h group (n = 32) and 72 h-5d group (n = 31), based on the timing of the intervention. The Kaplan-Meier curves demonstrated that there were no significant differences in the cumulative incidence of death (22.3% ± 7.4% vs. 19.9% ± 7.3%, log-rank P = 0.849), variceal rebleeding (9.7% ± 5.3% vs. 17.8% ± 7.3%, log-rank P = 0.406), OHE (28.5% ± 8.0% vs. 23.9% ± 8.0%, log-rank P = 0.641) and shunt dysfunction (8.6% ± 6.0% vs. 17.4% ± 8.1%, log-rank P = 0.328) between <72 h and 72 h-5d groups. In the total cohort, sarcopenia was identified as an independent risk factor for mortality (HR = 11.268, 95% CI = 1.435-88.462, P = 0.021) and OHE(HR = 12.504, 95% CI = 1.598-97.814, P = 0.016). In conclusion, the clinical outcomes of cirrhotic patients with AVB who underwent pTIPS within the 72-h to 5-day window were found to be comparable to those treated within the 72-h window.

Keywords: Acute variceal bleeding; Pre-emptive TIPS; Prognosis; Sarcopenia; Time window.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Study design and flowchart.
Fig. 2
Fig. 2
The changes of portal pressure gradient (PPG) in <72 h and 72 h-5d groups.
Fig. 3
Fig. 3
Kaplan-Meier curves for survival (A), overt hepatic encephalopathy (OHE) (B), variceal rebleeding (C) and shunt dysfunction (D) in <72 h and 72 h-5d groups.
See this image and copyright information in PMC

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