Follow-up study of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension.

Objective: To evaluate efficacy and complications for cirrhotic patients with variceal bleeding receiving TIPS.

Methods: Of 137 patients who underwent TIPS from 2002 to 2009, 80 patients were included in this study. Information about the incidence of portosystemic encephalopathy (PSE) and rebleeding, and factors then which affected them, was collected by telephone call, letters, or follow-up visits in the out-patient department.

Results: (1) TIPS can significantly reduce portal pressure and the risk of variceal bleeding. (2) A coated stent during TIPS can significantly reduce the occurrence of rebleeding in contrast with use of a bare stent (13.51% vs. 32.56%, P < 0.05). (3) Incidence of PSE is related to the diameter of the stent; the wider the stent used, the greater the incidence of PSE. TIPS using the left branch of the portal vein can reduce the incidence of PSE. (4) TIPS combined with embolization has no effect on the incidence of rebleeding or PSE. (5) Mean survival was 77.098 months (95% CI, 68.568-85.628) and median survival 82.000 months (95% CI, 68.539-95.461) according to Kaplan-Meier survival analysis.

Conclusion: It is suggested that coated stents should be used to reduce rebleeding. It is recommended that 8 mm stents should be used for CHILD A and C patients and 8-10 mm stents for CHILD B patients during TIPS, and that TIPS should be considered as first-line therapy because it improves cumulative survival for cirrhotic patients with gastroesophageal variceal bleeding.