Preemptive-TIPS improves outcome in high-risk variceal bleeding

An observational study

International Variceal Bleeding Observational Study Group and Baveno Cooperation

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Resumé

Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.

OriginalsprogEngelsk
TidsskriftHepatology (Baltimore, Md.)
Vol/bind69
Udgave nummer1
Sider (fra-til)282-293
ISSN0270-9139
DOI
StatusUdgivet - 1. jan. 2019

Fingeraftryk

Transjugular Intrahepatic Portasystemic Shunt
Treatment Failure
Child Mortality
Hepatic Encephalopathy
Guidelines
Incidence

Citer dette

International Variceal Bleeding Observational Study Group and Baveno Cooperation (2019). Preemptive-TIPS improves outcome in high-risk variceal bleeding: An observational study. Hepatology (Baltimore, Md.), 69(1), 282-293. https://doi.org/10.1002/hep.30182
International Variceal Bleeding Observational Study Group and Baveno Cooperation. / Preemptive-TIPS improves outcome in high-risk variceal bleeding : An observational study. I: Hepatology (Baltimore, Md.). 2019 ; Bind 69, Nr. 1. s. 282-293.
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title = "Preemptive-TIPS improves outcome in high-risk variceal bleeding: An observational study",
abstract = "Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22{\%} vs. 47{\%} in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92{\%} vs. 74{\%} in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.",
author = "Virginia Hern{\'a}ndez-Gea and Bogdan Procopet and {\'A}lvaro Gir{\'a}ldez and Lucio Amitrano and Candid Villanueva and Dominique Thabut and Luis Iba{\~n}ez-Samaniego and Gilberto Silva-Junior and Javier Martinez and Joan Genesc{\`a} and Christophe Bureau and Jonel Trebicka and Elba Llop and Wim Laleman and Palazon, {J M} and Jose Castellote and Susana Rodrigues and Gluud, {Lise L} and {Noronha Ferreira}, Carlos and Rafael Barcelo and Nuria Ca{\~n}ete and Manuel Rodr{\'i}guez and Arnulf Ferlitsch and Mundi, {Jose Luis} and Henning Gronbaek and Manuel Hern{\'a}ndez-Guerra and Romano Sassatelli and Alessandra Dell'Era and Marco Senzolo and Abraldes, {Juan G} and Manuel Romero-G{\'o}mez and Alexander Zipprich and Meritxell Casas and Helena Masnou and Massimo Primignani and Aleksander Krag and Frederik Nevens and Calleja, {Jose Luis} and Christian Jansen and Robic, {Marie Ang{\`e}le} and Irene Conejo and Maria-Vega Catalina and Agustin Albillos and Marika Rudler and Edilmar Alvarado and Guardascione, {Maria Anna} and Marcel Tantau and Jaime Bosch and Ferran Torres and Garcia-Pag{\'a}n, {Juan Carlos} and {International Variceal Bleeding Observational Study Group and Baveno Cooperation}",
note = "{\circledC} 2018 by the American Association for the Study of Liver Diseases.",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/hep.30182",
language = "English",
volume = "69",
pages = "282--293",
journal = "Hepatology",
issn = "0270-9139",
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International Variceal Bleeding Observational Study Group and Baveno Cooperation 2019, 'Preemptive-TIPS improves outcome in high-risk variceal bleeding: An observational study', Hepatology (Baltimore, Md.), bind 69, nr. 1, s. 282-293. https://doi.org/10.1002/hep.30182

Preemptive-TIPS improves outcome in high-risk variceal bleeding : An observational study. / International Variceal Bleeding Observational Study Group and Baveno Cooperation.

I: Hepatology (Baltimore, Md.), Bind 69, Nr. 1, 01.01.2019, s. 282-293.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Preemptive-TIPS improves outcome in high-risk variceal bleeding

T2 - An observational study

AU - Hernández-Gea, Virginia

AU - Procopet, Bogdan

AU - Giráldez, Álvaro

AU - Amitrano, Lucio

AU - Villanueva, Candid

AU - Thabut, Dominique

AU - Ibañez-Samaniego, Luis

AU - Silva-Junior, Gilberto

AU - Martinez, Javier

AU - Genescà, Joan

AU - Bureau, Christophe

AU - Trebicka, Jonel

AU - Llop, Elba

AU - Laleman, Wim

AU - Palazon, J M

AU - Castellote, Jose

AU - Rodrigues, Susana

AU - Gluud, Lise L

AU - Noronha Ferreira, Carlos

AU - Barcelo, Rafael

AU - Cañete, Nuria

AU - Rodríguez, Manuel

AU - Ferlitsch, Arnulf

AU - Mundi, Jose Luis

AU - Gronbaek, Henning

AU - Hernández-Guerra, Manuel

AU - Sassatelli, Romano

AU - Dell'Era, Alessandra

AU - Senzolo, Marco

AU - Abraldes, Juan G

AU - Romero-Gómez, Manuel

AU - Zipprich, Alexander

AU - Casas, Meritxell

AU - Masnou, Helena

AU - Primignani, Massimo

AU - Krag, Aleksander

AU - Nevens, Frederik

AU - Calleja, Jose Luis

AU - Jansen, Christian

AU - Robic, Marie Angèle

AU - Conejo, Irene

AU - Catalina, Maria-Vega

AU - Albillos, Agustin

AU - Rudler, Marika

AU - Alvarado, Edilmar

AU - Guardascione, Maria Anna

AU - Tantau, Marcel

AU - Bosch, Jaime

AU - Torres, Ferran

AU - Garcia-Pagán, Juan Carlos

AU - International Variceal Bleeding Observational Study Group and Baveno Cooperation

N1 - © 2018 by the American Association for the Study of Liver Diseases.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.

AB - Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.

U2 - 10.1002/hep.30182

DO - 10.1002/hep.30182

M3 - Journal article

VL - 69

SP - 282

EP - 293

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 1

ER -

International Variceal Bleeding Observational Study Group and Baveno Cooperation. Preemptive-TIPS improves outcome in high-risk variceal bleeding: An observational study. Hepatology (Baltimore, Md.). 2019 jan 1;69(1):282-293. https://doi.org/10.1002/hep.30182