A comparative study of emergency transjugular intrahepatic portosystemic stent-shunt and esophageal transection in the management of uncontrolled XXXX .

@entity1 @entity82 @entity101 @entity548 @entity75 @entity409
OBJECTIVES: Transjugular intrahepatic portosystemic stent-shunts (TIPSS) have been shown to reduce portal @entity101 consistently and have recently been reported to @entity548 . This retrospective and nonrandomized study compares the results of TIPSS with esophageal transection (ET) and devascularization in @entity1 with uncontrolled @entity548 admitted to a single center with an interest in variceal @entity548 . @entity1 AND METHODS: Two hundred and sixty cirrhotic @entity1 have been referred with variceal @entity548 over the past 7 yr. In 41 @entity1 (15.8%), @entity548 was uncontrolled despite two treatments with sclerotherapy. Thirty-eight @entity1 were eligible for analysis. Nineteen were considered for ET and 19 for TIPSS. @entity1 in the two groups were well matched for age, sex, etiology of @entity409 , and its severity and complications. They have been followed for 13 @entity1 years (TIPSS-7, longest 20 months; ET-6, longest 23 months). Data for survival and rebleeding were analyzed by the Kaplan-Meier method on an intention-to-treat basis. RESULTS: Seven of the 19 were considered unfit for surgery, and 12 underwent esophageal transection and devascularization. TIPSS was undertaken successfully in 17 @entity1 , the Palmaz stent being used in 4 and the Wallstent in 13. Successful TIPSS reduced the mean portal pressure gradient from 22.2 (SE 1.2) to 9.7 (SE 0.7) mm Hg (p < 0.001). Mortality within 30 days of the initial bleed was 42% in the TIPSS group compared with 79% in the ET group (p < 0.05). Rebleeding occurred in 15.6% @entity1 with TIPSS, compared with 26.2% in the ET group. @entity75 in the two groups of @entity1 was not significantly different (TIPSS 25% and ET 22%). TIPSS was followed by active infection in 20% compared with 36% after ET. CONCLUSIONS: This study shows that the overall mortality in this group of @entity1 is high whatever the type of treatment used. TIPSS can be performed successfully on these @entity1 who are often not suitable for surgery. Mortality rates were significantly lower in @entity1 treated by TIPSS. Compared with ET, TIPSS should be regarded as the preferred mode of treatment for uncontrolled @entity548 in @entity1 with @entity82 .
