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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 10
Oct.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(10): 2460-2463

Transjugular intrahepatic portosystemic shunt combined with collateral vessel embolization in treatment of gastroesophageal variceal bleeding in liver cirrhosis： Research advances and controversies

DOI: 10.3969/j.issn.1001-5256.2023.10.026
  • 1.

    Department of Gastroenterology，Shandong Provincial Hospital Affiliated to Shandong First Medical University，Jinan 250021，China

  • 2.

    Department of Infectious Diseases，Qilu Hospital，Shandong University，Jinan 250021，China

Research funding:

‍National Natural Science Foundation of China (81970533);

Natural Science Foundation of Shandong Province (ZR2022ZD21)

More Information
  • Corresponding author: ZHANG Chunqing， zhangchunqing_sdu@163.com （ORCID： 0000－0001－8711－1579）
  • Received Date: 2023-01-14
  • Published Date: 2023-10-30
    Abstract
  • Transjugular intrahepatic portosystemic shunt （TIPS） has been recommended as a treatment method for cirrhotic portal hypertension in domestic and foreign guidelines， but there is still uncertainty in its therapeutic efficacy. More and more studies have shown that TIPS combined with collateral vessel embolization （TIPS+E） has certain advantages in the treatment of gastroesophageal variceal bleeding in liver cirrhosis. This article reviews the major studies on TIPS+E in China and globally， summarizes related recommendations in guidelines and the current status of clinical application， and proposes the issues that need to be solved， such as indication， hemodynamic criteria， and selection of materials for embolization， and large－sample multicenter randomized controlled trials are needed for further clarification.

     

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    • References(29)
  • [1]
    de FRANCHIS R, Faculty Baveno VI. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63( 3): 743－ 752. DOI: 10.1016/j.jhep.2015.05.022.
    [2]
    TRIPATHI D, STANLEY AJ, HAYES PC, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut, 2015, 64( 11): 1680－ 1704. DOI: 10.1136/gutjnl－2015－309262.
    [3]
    BRUNNER F, BERZIGOTTI A, BOSCH J. Prevention and treatment of variceal haemorrhage in 2017[J]. Liver Int, 2017, 37( Suppl 1): 104－ 115. DOI: 10.1111/liv.13277.
    [4]
    GARCIA－TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65( 1): 310－ 335. DOI: 10.1002/hep.28906.
    [5]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69( 2): 406－ 460. DOI: 10.1016/j.jhep.2018.03.024.
    [6]
    BOIKE JR, THORNBURG BG, ASRANI SK, et al. North American Practice－Based Recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension[J]. Clin Gastroenterol Hepatol, 2022, 20( 8): 1636－ 1662. DOI: 10.1016/j.cgh.2021.07.018.
    [7]
    de FRANCHIS R, BOSCH J, GARCIA－TSAO G, et al. Baveno VII－ Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76( 4): 959－ 974. DOI: 10.1016/j.jhep.2021.12.022.
    [8]
    The Chinese College of Interventionalists. CCI clinical practice guidelines: Management of TIPS for portal hypertension(2019 edition)[J]. J Clin Hepatol, 2019, 35( 12): 2694－ 2699. DOI: 10.3969/j.issn.1001－5256.2019.12.010.

    中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35( 12): 2694－ 2699. DOI: 10.3969/j.issn.1001－5256.2019.12.010.
    [9]
    TESDAL IK, FILSER T, WEISS C, et al. Transjugular intrahepatic portosystemic shunts: adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding[J]. Radiology, 2005, 236( 1): 360－ 367. DOI: 10.1148/radiol.2361040530.
    [10]
    GABA RC, BUI JT, COTLER SJ, et al. Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization[J]. Hepatol Int, 2010, 4( 4): 749－ 756. DOI: 10.1007/s12072－010－9206－2.
    [11]
    CHEN S, LI X, WEI B, et al. Recurrent variceal bleeding and shunt patency: prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization[J]. Radiology, 2013, 268( 3): 900－ 906. DOI: 10.1148/radiol.13120800.
    [12]
    YU J, WANG X, JIANG M, et al. Comparison of transjugular intrahepatic portosystemic shunt(TIPS) alone and combined with embolisation for the management of cardiofundal varices: a retrospective study[J]. Eur Radiol, 2019, 29( 2): 699－ 706. DOI: 10.1007/s00330－018－5645－2.
    [13]
    SHI Y, TIAN X, HU J, et al. Efficacy of transjugular intrahepatic portosystemic shunt with adjunctive embolotherapy with cyanoacrylate for esophageal variceal bleeding[J]. Dig Dis Sci, 2014, 59( 9): 2325－ 2332. DOI: 10.1007/s10620－014－3150－2.
    [14]
    QI X, LIU L, BAI M, et al. Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: a meta－analysis[J]. J Gastroenterol Hepatol, 2014, 29( 4): 688－ 696. DOI: 10.1111/jgh.12391.
    [15]
    XIAO T, CHEN L, CHEN W, et al. Comparison of transjugular intrahepatic portosystemic shunt(TIPS) alone versus TIPS combined with embolotherapy in advanced cirrhosis: a retrospective study[J]. J Clin Gastroenterol, 2011, 45( 7): 643－ 650. DOI: 10.1097/MCG.0b013e318203dfb3.
    [16]
    XUE H, YUAN J, CHAO－LI Y, et al. Follow－up study of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension[J]. Dig Dis Sci, 2011, 56( 11): 3350－ 3356. DOI: 10.1007/s10620－011－1744－5.
    [17]
    JAJU P, AMIN S, SZE DY, et al. Effect of embolization or sclerosis on recurrence of variceal hemorrhage after transjugular intrahepatic portosystemic shunt placement[J]. J Vasc Interv Radiol, 2014, 25( 3): S83. DOI: 10.1016/j.jvir.2013.12.235.
    [18]
    WEBER CN, GE BH, CLARK T, et al. Clinical outcomes of selective variceal coil embolization during PTFE－covered transjugular intrahepatic portosystemic shunt(TIPS) placement for variceal hemorrhage[J]. J Vasc Interv Radiol, 2015, 26( 2): S92－S93. DOI: 10.1016/j.jvir.2014.12.252.
    [19]
    SHAH KY, REN A, SIMPSON RO, et al. Combined transjugular intrahepatic portosystemic shunt plus variceal obliteration versus transjugular intrahepatic portosystemic shunt alone for the management of gastric varices: comparative single－center clinical outcomes[J]. J Vasc Interv Radiol, 2021, 32( 2): 282－ 291. DOI: 10.1016/j.jvir.2020.10.009.
    [20]
    LAKHOO J, BUI JT, LOKKEN RP, et al. Transjugular intrahepatic portosystemic shunt creation and variceal coil or plug embolization ineffectively attain gastric variceal decompression or occlusion: results of a 26－patient retrospective study[J]. J Vasc Interv Radiol, 2016, 27( 7): 1001－ 1011. DOI: 10.1016/j.jvir.2016.02.019.
    [21]
    LV Y, CHEN H, LUO B, et al. Transjugular intrahepatic portosystemic shunt with or without gastro－oesophageal variceal embolisation for the prevention of variceal rebleeding: a randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2022, 7( 8): 736－ 746. DOI: 10.1016/S2468－1253(22)00087－5.
    [22]
    HE C, LV Y, WANG Z, et al. Association between non－variceal spontaneous portosystemic shunt and outcomes after TIPS in cirrhosis[J]. Dig Liver Dis, 2018, 50( 12): 1315－ 1323. DOI: 10.1016/j.dld.2018.05.022.
    [23]
    LENG X, ZHANG F, ZHANG M, et al. Comparison of transjugular intrahepatic portosystemic shunt for treatment of variceal bleeding in patients with cirrhosis with or without spontaneous portosystemic shunt[J]. Eur J Gastroenterol Hepatol, 2019, 31( 7): 853－ 858. DOI: 10.1097/MEG.0000000000001349.
    [24]
    LV Y, CHEN H, LUO B, et al. Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: A randomized controlled trial[J]. Hepatology, 2022, 76( 3): 676－ 688. DOI: 10.1002/hep.32453.
    [25]
    SCHULTHEIß M, GIESLER M, MARUSCHKE L, et al. Adjuvant transjugular variceal occlusion at creation of a transjugular intrahepatic portosystemic shunt(TIPS): Efficacy and risks of bucrylate embolization[J]. Cardiovasc Intervent Radiol, 2019, 42( 5): 729－ 736. DOI: 10.1007/s00270－019－02176－y.
    [26]
    BOSCH J. Small diameter shunts should lead to safe expansion of the use of TIPS[J]. J Hepatol, 2021, 74( 1): 230－ 234. DOI: 10.1016/j.jhep.2020.09.018.
    [27]
    SARWAR A, ESPARAZ AM, TAPPER EB, et al. Comparison of vascular plugs and pushable coils for variceal embolization after TIPS[J]. AJR Am J Roentgenol, 2017, 208( 3): 650－ 655. DOI: 10.2214/AJR.16.16012.
    [28]
    ZHOU L, ZHONG B, DU H, et al. Comparison of embolic agents for varices during transjugular intrahepatic portosystemic shunt for variceal bleeding: Tissue gel or coil?[J]. J Interv Med, 2020, 3( 4): 195－ 200. DOI: 10.1016/j.jimed.2020.08.008.
    [29]
    WOLTER K, PRAKTIKNJO M, BOIE J, et al. Glue embolization of gastroesophageal varices during transjugular intrahepatic portosystemic shunt(TIPS) improves survival compared to coil－only embolization－a single－center retrospective study[J]. Cardiovasc Intervent Radiol, 2021, 44( 8): 1240－ 1250. DOI: 10.1007/s00270－021－02852－y.
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