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J Hepatol. 2017 Sep 13. pii: S0168-8278(17)32281-X. doi: 10.1016/j.jhep.2017.09.002. [Epub ahead of print]

Cirrhotic patients with portal hypertension-related bleeding and an indication for early-TIPS: a large multicentre audit with real-life results.

Author information

1
Sorbonne Universités, UPMC Univ Paris 06, Paris, France; AP-HP, UF de Soins Intensifs d'Hépato-Gastroentérologie, Service d'Hépato-Gastroentérologie, Groupe hospitalier Pitié Salpêtrière, Paris, France. Electronic address: dominique.thabut@psl.aphp.fr.
2
Service d'Hépato-Gastroentérologie, Centre Hospitalier, Gonesse Cedex, France.
3
AP-HP, Service d'Hépato-Gastroentérologie, Hôpital Saint-Antoine, Paris, France.
4
Service d'Hépato-Gastroentérologie, Centre hospitalier de Perpignan, France.
5
AP-HP, Service d'Hépatologie, Hôpital Jean Verdier, Bondy, France.
6
Service d'Hépato-Gastroentérologie, CHR Orléans, Orléans, France.
7
Service d'Hépatologie, CHU de Besançon, Besançon, France.
8
Centre Hospitalier Laennec, GHPSO, Service d'hHépato-Gastroentérologie et de Nutrition, Creil cedex, France.
9
Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France.
10
Service d'Hépato-Gastroentérologie, CHR Avignon, Avignon, France.
11
Service d'Hépato-Gastroentérologie, CHU de Reims, Reims cedex, France.
12
Service d'Hépato-Gastroentérologie, Hôpital Saint-Musse, Toulon, France.
13
Service d'Hépato-Gastroentérologie, CHU de Dijon, Dijon cedex, France.
14
Service d'Hépato-Gastroentérologie, CH de Pau, Pau cedex, France.
15
Service Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France.
16
Service Hépato-gastroentérologie, CH d'Angoulème, Angoulème cedex, France.
17
AP-HP, Service d'Hépato-gastroentérologie, CHU Bichat, Paris, France.
18
Service d'Hépato-Gastroentérologie, Hôpital St Denis, St Denis cedex, France.
19
CHU Pontchaillou, Service d'Hépatologie, Rennes, France.
20
Service de Gastro-Entérologie, Centre Hospitalier Intercommunal de Poissy, Poissy, France.
21
Service d'Hépato-Gastroentérologie. Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
22
Sorbonne Universités, UPMC Univ Paris 06, Paris, France; AP-HP, UF de Soins Intensifs d'Hépato-Gastroentérologie, Service d'Hépato-Gastroentérologie, Groupe hospitalier Pitié Salpêtrière, Paris, France.
23
Service d'Hépato-gastroentérologie, Hôpital Purpan Centre Hospitalier Universitaire Toulouse, Toulouse Cedex, France; Université Paul Sabatier Toulouse III, Toulouse Cedex, France.

Abstract

BACKGROUND:

The Baveno VI consensus meeting concluded that an early TIPS must be considered in high-risk cirrhotic patients presenting with variceal bleeding (VB) (Child B + active bleeding at endoscopy or Child C10-13 patients). Whether this therapeutic approach is feasible in a real-life setting remains unclear.

AIMS:

To determine (1) the proportion of patients eligible for early-TIPS among cirrhotic patients with VB, (2) the proportion of these patients who underwent early-TIPS placement and the main reasons for discarding TIPS, and (3) the outcomes of patients who experienced early-TIPS placement in a large, national, prospective, multicentre audit including academic and non-academic centres.

MATERIALS AND METHODS:

All French centres recruiting gastrointestinal bleeding were invited to participate. All consecutive patients with cirrhosis and PHT-related bleeding were included.

RESULTS:

964 patients were included (58 centres: 26 academic, 32 non-academic; patient characteristics: male sex, 77%; age, 59.6 ± 12.1 years; aetiologies of cirrhosis (alcoholic,viral/other, 67%/15%/18%); source of bleeding (EV/GV/other, 80/11/9%); active bleeding at endoscopy 34%; Child A 21%/B 44%/C 35%. Overall, 35% of the patients were eligible for early-TIPS, but only 6.8%, displaying less severe cirrhosis underwent early-TIPS placement. The main reason for discarding TIPS was a lack of availability. The actuarial probability of survival at one year was significantly increased in early-TIPS patients (85.7±0.07% vs 58.9±0.03%, p=0.04). The severity of liver disease was the only parameter independently associated with improved one-year survival.

CONCLUSION:

In this real-life study, one-third of the cirrhotic patients admitted for VB fulfilled the criteria for early-TIPS placement, whereas only 7% had access to TIPS. TIPS was restricted to patients displaying less severe cirrhosis. The severity of liver disease was the only parameter that influenced survival.

KEYWORDS:

Cirrhosis; Portal hypertension; Real-life; TIPS; Variceal bleeding

PMID:
28918131
DOI:
10.1016/j.jhep.2017.09.002

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