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Endoscopic Treatment as the Rescue Therapy for Recurrent Bleeding after Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Gastroenterology Research and Practice ( IF 2 ) Pub Date : 2021-08-02 , DOI: 10.1155/2021/6627837
Liyuan Ni 1 , Xiaoquan Huang 1 , Siyu Jiang 1 , Lili Ma 2 , Jianjun Luo 3 , Shiyao Chen 1, 2
Affiliation  

Background. Transjugular intrahepatic portosystemic shunt (TIPS) is suggested as the salvage therapy for gastroesophageal variceal bleeding in cirrhosis. However, rebleeding might occur in some patients after TIPS. Currently, there is a lack of evidence in the endoscopic management of recurrent bleeding in these patients. Aims. To evaluate the efficacy of endoscopic treatment in cirrhotic patients with recurrent bleeding after TIPS. Methods. Cirrhotic patients with gastroesophageal varices who received endoscopic treatment for recurrent bleeding after TIPS were included. Results. 6 patients were enrolled in this study. The median age of the patients was 47 years (range 27 to 65 years), and the duration of follow-up time was 346 (17-773) days. Stent stenosis or occlusion was found in 5 out of 6 patients after TIPS. Salvage endoscopic treatment, including esophageal variceal ligation (EVL), gastric variceal cyanoacrylate injection, esophageal variceal sclerotherapy, and balloon-occluded retrograde transvenous obliteration- (BRTO-) assisted endoscopic cyanoacrylate injection. Among included patients, 2 died shortly after EVL (14 and 19 days) due to variceal bleeding. Among other 4 patients, 2 had rebleeding episodes at 422 and 789 days, respectively. Conclusion. Endoscopic treatment may be an option for recurrent bleeding after TIPS in selected patients. Further studies are needed to carefully define the indication and efficacy of this option.

中文翻译:

内镜治疗作为经颈静脉肝内门体分流术 (TIPS) 后复发性出血的抢救治疗

背景。经颈静脉肝内门体分流术(TIPS)被建议作为肝硬化胃食管静脉曲张出血的抢救疗法。然而,一些患者在 TIPS 后可能会发生再出血。目前,缺乏内镜治疗这些患者复发性出血的证据。目标。评价内镜治疗对肝硬化 TIPS 术后复发性出血患者的疗效。方法。包括因 TIPS 后复发性出血而接受内镜治疗的胃食管静脉曲张肝硬化患者。结果. 6名患者参加了这项研究。患者的中位年龄为 47 岁(范围 27 至 65 岁),随访时间为 346(17-773)天。TIPS 后 6 名患者中有 5 名发现支架狭窄或闭塞。抢救性内镜治疗,包括食管静脉曲张结扎术(EVL)、胃静脉曲张氰基丙烯酸酯注射液、食管静脉曲张硬化治疗和球囊封堵逆行经静脉闭塞术(BRTO-)辅助内镜下氰基丙烯酸酯注射液。在纳入的患者中,2 名在 EVL 后不久(14 天和 19 天)因静脉曲张出血而死亡。在其他 4 名患者中,2 名患者分别在 422 天和 789 天再次出血。结论. 内镜治疗可能是特定患者 TIPS 后复发性出血的一种选择。需要进一步的研究来仔细定义该选项的适应症和有效性。
更新日期:2021-08-02
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