Safety and clinical efficacy of TIPS with various stents for treatment of cirrhosis with esophageal gastric varices bleeding / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To assess the safety and clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with various stents for treating patients with cirrhosis and esophageal gastric varices bleeding.</p><p><b>METHODS</b>One hundred and five patients were stratified according to stent type: bare stent group, covered stent-grafts group, combined stents group. Rates of success, shunt insufficiency, rebleeding, patient survival, and major complications were observed. The shunt insufficiency rate, rebleeding rate, and survival rate were calculated by the life tables method, the Kaplan-Meier analytical curve, and the log-rank test; a p-value less than 0.05 was considered statistically significant.</p><p><b>RESULTS</b>The overall success rate of all TIPS for treating the esophageal gastric varices bleeding was 100%. The overall shunt insufficiency rates at 6-, 12-and 24-months post-TIPS were 8%, 9% and 16%, rebleeding rates were 2%, 6% and 17%, and survival rates were 100%, 97% and 94%. The shunt insufficiency rate was 26% in the bare stent group, 14% in the covered stent-grafis group, and 5% in the combined stents group (x2=1.00, P=0.61). The rebleeding rate was 33% in the bare stent group, 7% in the covered stent-grafts group, and 3%in the combined stents group (x2=1.69, P=0.43). The survival rate was 92% in the bare stent group, 93% in the covered stent-grafts group, and 100% in the combined stents group (x2=1.91, P=0.39). The shunt insufficiency rates were higher in patients with splenectomy than in those without splenectomy (30% vs.14%; x2=4.15, P=0.04). The intraperitoneal hemorrhage rates in the covered stent-grafis group and the combined stents group were significantly lower than that in the bare stent group (0% vs 0% vs 13%; x2=8.88, P=0.01).</p><p><b>CONCLUSIONS</b>TIPS with an 8 mm stent effectively treated and prevented esophageal gastric varices bleeding in patients with cirrhosis. Intraperitoneal hemorrhaging caused by TIPS was significantly decreased in the covered stent-grafts group and combined stents group,which represented an improvement in safety of this treatment. However, the influence of covered stent-grafis and combined stents towards the clinical efficacy of TIPS needs further study.</p>

Correlation between hepatic venous pressure gradient and clinic features in patients with liver cirrhosis / 中华消化杂志

Objective To investigate the correlation between hepatic venous pressure gradient (HVPG) and clinic features ,laboratory results in patients with liver cirrhosis .Methods From December 2012 to April 2014 ,patients with liver cirrhosis who received HVPG examination were enrolled .The clinical data of the patients were collected ,which included etiology of cirrhosis ,albumin ,creatine ,total bilirubin ,international normal ratio (INR) ,history of ascite and bleeding ,degree of gastroesophageal varices under endoscopy ,the scores of Child‐Pugh and model for end‐stage liver disease (MELD) .Single factor and multiple factor linear regression method were performed to analyze the correlation between these indexes and HVPG .Results A total of 63 patients met the inclusion criteria .Among them ,six patients had abnormal shunt in liver venous and HVPG examination failed .The HVPG of the left 57 patients was 9 .50 to 33 .20 mmHg (1 mmHg = 0 .133 kPa) ,mean (16 .38 ± 5 .64) mmHg .The results of single factor regression analysis indicated that there were certain relevance between the level of albumin (r2 = 0 .145 , P= 0 .002) ,Child‐Pugh score (r2 = 0 .069 ,P= 0 .048) and HVPG .Multiple factor analysis indicated that there were certain relevance between albumin (B= - 4 .920 ,t= - 3 .521 ,P= 0 .001) ,total bilirubin (B =4 .066 ,t= 2 .206 ,P = 0 .032) and HVPG ,and there were no relevance between the other indexes and HVPG .Conclusion Only albumin and total bilirubin level in patients with liver cirrhosis are correlated with the level of HVPG .