Feasibility, safety, and clinical effect of establishing a green channel for the treatment of cirrhotic portal hypertension with esophagogastric variceal bleeding

Objective To investigate the feasibility, safety, and clinical effect of emergency transjugular intrahepatic portosystemic shunt ( TIPS) combined with esophagogastric variceal embolization ( EGVE) in establishing a green channel for the treatment of cirrhotic portal hypertension with esophagogastric variceal bleeding ( EGVB) . Methods A retrospective analysis was performed for the clinical data of 75 patients who underwent TIPS + EGVE in Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, from April 1, 2015 to December 31, 2017. Among these patients, 49 underwent emergency TIPS + EGVE and 26 underwent elective TIPS +EGVE. Postoperative hemostasis rate, length of hospital stay, rebleeding rate within 1 year after surgery, perioperative and postoperative complications, and mortality rate within 1 year after surgery were observed. The t-test was used for comparison of continuous data between the two groups, the chi-square test was used for comparison of categorical data between the two groups, and the Kaplan-Meier method was used to plot survival curves to compare rebleeding rate. Results All 75 patients underwent a successful surgery, with a hemostasis rate of 100% at 1 week after surgery. There was a significant difference in mean hospital stay between the emergency TIPS + EGVE group and the elective TIPS + EGVE group ( 6. 1 ± 1. 0 days vs 8. 1 ± 2. 1 days, t =-4. 685, P < 0. 001) . Among the patients in the emergency TIPS +EGVE group, 2 patients ( 4. 1%) experienced rebleeding, among whom 1 patient ( 2. 0%) experienced rebleeding and died at 2 months after surgery, and the other patient experienced rebleeding at 13 months after surgery and was cured and discharged after conservative treatment; 12 patients ( 24. 5%) had at least one episode of grade ≥2 hepatic encephalopathy during follow-up. Among the patients in the elective TIPS + EGVE group, 4 patients ( 15. 4%) experienced rebleeding after surgery, among whom 3 ( 11. 5%) died; 5 patients ( 19. 2%) had at least one episode of grade ≥2 hepatic encephalopathy, among whom one patient had three episodes of hepatic encephalopathy within one month after surgery. There were no significant differences between the two groups in cumulative rebleeding rate, mortality rate, and incidence rate of hepatic encephalopathy ( P > 0. 05) . Mean blood ammonia level reached the peak at 1 month after surgery and then gradually decreased. Among the 17 patients with hepatic encephalopathy, 11 ( 64. 7%) experienced hepatic encephalopathy within 1 month after surgery, and 15 ( 88. 2%) experienced such disease within 6 months after surgery. Conclusion Emergency TIPS combined with EGVE is feasible, safe, and effective in establishing a green channel in patients with liver cirrhosis and acute EGVB.