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Multicenter Study
. 2025 Jul 21;31(27):108483.
doi: 10.3748/wjg.v31.i27.108483.

Clinical efficacy of surgically assisted transjugular intrahepatic portosystemic shunt for cavernous transformation of portal vein

Yi-Fan Wu  1 , Zhen-Dong Yue  1 , Zhen-Hua Fan  1 , Cheng-Bin Dong  1 , Yu Zhang  1 , Qi-Mei Li  1 , Dong-Fang Liu  1 , Guang-Zhong Xu  2 , De-Zhong Wang  2 , Hai-Ming Zhao  3 , Zhi-Ping Wu  4 , Lei Wang  5
Affiliations
Multicenter Study

Clinical efficacy of surgically assisted transjugular intrahepatic portosystemic shunt for cavernous transformation of portal vein

Yi-Fan Wu et al. World J Gastroenterol. .

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is contraindicated for patients with cavernous transformation of the portal vein (CTPV) due to high surgery-related mortality risk. However, surgically assisted TIPS (SATIPS) can significantly reduce the risk.

Aim: To evaluate the clinical efficacy of SATIPS, this study was conducted.

Methods: One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals. Overall, 54 patients received SATIPS treatment (SATIPS group), while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation (control group). Subsequently, survival rates, incidence rates of gastrointestinal bleeding, incidence of hepatic encephalopathy rate, and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.

Results: The survival rates for the SATIPS and control groups were 94.4% and 92.5% at 3 months (P value = 0.72) and 94.4% and 73.6% at 6 months (P value = 0.0051) respectively. The incidence of liver failure was 3.7% and 9.4% at 3 months (P value = 0.26) and 3.7% and18.9% at 6 months (P value = 0.016); the incidence of gastrointestinal bleeding was 5.6% and 37.7% at 3 months (P value < 0.001) and 9.3% and 47.2% (P value < 0.001) at 6 months; and the incidence of hepatic encephalopathy was 3.7% and 17.0% at 3 months (P value = 0.026) and 7.4% and 26.4% at 6 months (P value = 0.026) respectively.

Conclusion: For patients with CTPV, there were no optimal treatment. Regarding long-term efficacy, SATIPS can significantly reduce the rate of rebleeding, hepatic encephalopathy and liver failure, and is associated with better survival.

Keywords: Cavernous transformation of portal vein; Esophagogastric variceal bleeding; Portal hypertension; Portal vein thrombosis; Surgically assisted transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Intraoperative photographs and medical imaging records. A: Intraoperative pictures of open abdominal surgery; B-F: Intraoperative pictures of interventional surgery.
Figure 2
Figure 2
Survival, hepatic encephalopathy, gastrointestinal rebleeding and liver failure incidence curves between the surgically assisted transjugular intrahepatic portosystemic shunt group and control group. A and B: Incidence curves of liver failure at three and six months in the two groups; C and D: Incidence curves of hepatic encephalopathy at three and six months in the two groups; E and F: Survival curves at three and six months in the two groups; G and H: Incidence curves of gastrointestinal rebleeding at three and six months in the two groups. SATIPS: Surgically assisted transjugular intrahepatic portosystemic shunt.
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