Percutaneous transhepatic portal vein stenting as rescue treatment for recurrent oesophageal variceal bleeding in a 31-year-old woman with haepatocellular carcinoma in a non-cirrhotic liver

A 31-year-old woman with hepatocellular carcinoma suffered from recurrent oesophageal variceal bleeding due to portal hypertension, which was caused by severe compression of the portal vein by metastatic lymph nodes. Endoscopic band ligation and pharmacological treatment did not suffice to prevent recurrence of variceal bleeding. Eventually, after the fifth variceal bleeding within 6 months, the patient was admitted to the intensive care unit in a haemodynamic shock. A Sengstaken-Blakemore tube was inserted and all treatment options were discussed, but only percutaneous transhepatic recanalisation of the portal vein with stent placement to reduce portal vein pressure was thought to be feasible with any chance to relieve portal vein pressure. After successful portal vein stenting, our patient did not have any recurrent bleeding in the remaining year of her life. We suggest that percutaneous transhepatic portal vein stenting may be a feasible and adequate last line treatment for complications of portal hypertension.

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The Surgical Treatment for Portal Hypertension: A Systematic Review and Meta-Analysis

ISRN Gastroenterology ◽

10.1155/2013/464053 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Lanning Yin ◽

Haipeng Liu ◽

Youcheng Zhang ◽

Wen Rong

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Variceal Bleeding ◽

Meta Analysis ◽

Portal Pressure ◽

Combined Treatment ◽

Cochrane Library ◽

Quality Of Reporting ◽

Portal Vein Pressure ◽

Shunt Procedure

Aim. To compare the effectiveness of surgical procedures (selective or nonselective shunt, devascularization, and combined shunt and devascularization) in preventing recurrent variceal bleeding and other complications in patients with portal hypertension. Methods. A systematic literature search of the Medline and Cochrane Library databases was carried out, and a meta-analysis was conducted according to the guidelines of the Quality of Reporting Meta-Analyses (QUOROM) statement. Results. There were a significantly higher reduction in rebleeding, yet a significantly more common encephalopathy () in patients who underwent the shunt procedure compared with patients who had only a devascularization procedure. Further, there were no significant differences in rebleeding, late mortality, and encephalopathy between selective versus non-selective shunt. Next, the decrease of portal vein pressure, portal vein diameter, and free portal pressure in patients who underwent combined treatment with shunt and devascularization was more pronounced compared with patients who were treated with devascularization alone (). Conclusions. This meta-analysis shows clinical advantages of combined shunt and devascularization over devascularization in the prevention of recurrent variceal bleeding and other complications in patients with portal hypertension.

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Stent patency and outcome of TIPS through the left versus the right portal branches

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00305-z ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Mohamed S. Alwarraky ◽

Hasan A. Elzohary ◽

Mohamed A. Melegy ◽

Anwar Mohamed

Keyword(s):

Portal Hypertension ◽

Clinical Outcome ◽

Portal Vein ◽

Variceal Bleeding ◽

Patency Rate ◽

Hospital Admissions ◽

Stent Patency ◽

Left Branch ◽

The Right

Abstract Background Our purpose is to compare the stent patency and clinical outcome of trans-jugular intra-hepatic porto-systemic shunt (TIPS) through the left branch portal vein (TIPS-LPV) to the standard TIPS through the right branch (TIPS-RPV). We retrospectively reviewed all patients (n = 54) with refractory portal hypertension who were subjected to TIPS-LPV at our institute (TIPS-LPV) between 2016 and 2018. These patients were matched with 56 control patients treated with the standard TIPS-RPV (TIPS-RPV). The 2 groups were compared regarding the stent patency rate, encephalopathy, and re-interventions for 1 year after the procedure. Results TIPS-LPV group showed 12 months higher patency rate (90.7% compared to 73.2%) (P < 0.005). The number of the encephalopathy attacks in the TIPS-LPV group was significantly lower than that of the TIPS-RPV group at 6 and 12 months of follow-up [P = 0.012 and 0.036, respectively]. Re-bleeding and improvement of ascites were the same in the two groups [P > 0.05]. Patients underwent TIPS-LPV needed less re-interventions and required less hospitalizations than those with TIPS-RPV [P = 0.039 and P = 0.03, respectively]. Conclusion The new TIPS approach is to extend the stent to LPV. This new TIPS-LPV approach showed the same clinical efficiency as the standard TIPS-RPV in treating variceal bleeding and ascites. However, it proved a better stent patency with lower rates of re-interventions, encephalopathy, and hospital admissions than TIPS through the right branch.

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Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial

Gut ◽

10.1136/gutjnl-2017-314634 ◽

2017 ◽

Vol 67 (12) ◽

pp. 2156-2168 ◽

Cited By ~ 38

Author(s):

Yong Lv ◽

Xingshun Qi ◽

Chuangye He ◽

Zhengyu Wang ◽

Zhanxin Yin ◽

...

Keyword(s):

Portal Hypertension ◽

Adverse Events ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Decompensated Cirrhosis ◽

Covered Stents ◽

Band Ligation ◽

Vein Thrombosis ◽

Cirrhotic Patients ◽

Endoscopic Band Ligation

ObjectiveLimited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol for the prevention of variceal rebleeding among patients with cirrhosis and PVT.DesignConsecutive cirrhotic patients (94% Child-Pugh class A or B) with PVT who had variceal bleeding in the past 6 weeks were randomly assigned to TIPS group (n=24) or EBL plus propranolol group (EBL+drug, n=25), respectively. Primary endpoint was variceal rebleeding. Secondary endpoints included survival, overt hepatic encephalopathy (OHE), portal vein recanalisation and rethrombosis, other complications of portal hypertension and adverse events.ResultsDuring a median follow-up of 30 months in both groups, variceal rebleeding was significantly less frequent in the TIPS group (15% vs 45% at 1 year and 25% vs 50% at 2 years, respectively; HR=0.28, 95% CI 0.10 to 0.76, p=0.008), with a significantly higher portal vein recanalisation rate (95% vs 70%; p=0.03) and a relatively lower rethrombosis rate (5% vs 33%; p=0.06) compared with the EBL+drug group. There were no statistically significant differences in survival (67% vs 84%; p=0.152), OHE (25% vs 16%; p=0.440), other complications of portal hypertension and adverse events between groups.ConclusionCovered TIPS placement in patients with PVT and moderately decompensated cirrhosis was more effective than EBL combined with propranolol for the prevention of rebleeding, with a higher probability of PVT resolution without increasing the risk of OHE and adverse effects, but this benefit did not translate into improved survival.Trial registration numberClinicalTrials.gov: NCT01326949.

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Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding

Radiology ◽

10.1148/radiol.15141252 ◽

2015 ◽

Vol 276 (1) ◽

pp. 286-293 ◽

Cited By ~ 43

Author(s):

Xuefeng Luo ◽

Zhu Wang ◽

Jiaywei Tsauo ◽

Biao Zhou ◽

Hailong Zhang ◽

...

Keyword(s):

Portal Vein ◽

Randomized Trial ◽

Portal Vein Thrombosis ◽

Variceal Bleeding ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Band Ligation ◽

Vein Thrombosis ◽

Advanced Cirrhosis ◽

Endoscopic Band Ligation

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TIPS: a new alternative for the variceal bleeder

American Journal of Critical Care ◽

10.4037/ajcc1993.2.3.196 ◽

1993 ◽

Vol 2 (3) ◽

pp. 196-201 ◽

Cited By ~ 1

Author(s):

L Adams ◽

MC Soulen

Keyword(s):

Portal Hypertension ◽

Hepatic Vein ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Variceal Bleeding ◽

Balloon Catheter ◽

Portosystemic Shunt ◽

Recurrent Bleeding ◽

Secondary Patency ◽

Secondary Patency Rate ◽

Intrahepatic Portosystemic Shunt

BACKGROUND: Standard medical therapies for variceal bleeding secondary to portal hypertension (vasopressin, esophagogastric balloon tamponade and sclerotherapy) are associated with high rates of recurrent bleeding. Surgical shunting has a mortality rate of 15% to 50%. The transjugular intrahepatic portosystemic shunt offers a novel, minimally invasive procedure for nonsurgical portal decompression. METHOD: Following catheterization of the hepatic vein from a jugular vein approach, a needle is directed fluoroscopically from the hepatic vein into a branch of the portal vein along an intrahepatic tract. The intrahepatic tract is then dilated and held open with a stainless steel stent delivered on a balloon catheter. This creates a portosystemic shunt entirely within the liver. RESULTS: The collective experience of more than 300 cases from several centers has been reported. The technical success rate for the transjugular intrahepatic portosystemic shunt is 92% to 96%. Thirty-day mortality rates range from 0% to 14%, with less than 3% attributed to procedural complications. Primary shunt patency is about 90%, with a secondary patency rate of 100%. Rates of encephalopathy and rebleeding are 9% to 14%. Ascites resolves in 80% to 90% of patients. CONCLUSION: The transjugular intrahepatic portosystemic shunt appears to be a safe and effective procedure for management of variceal bleeding and holds promise for becoming the treatment of choice for portal hypertension.

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Propranolol for portal hypertension. Evaluation of therapeutic response by direct measurement of portal vein pressure

Archives of Internal Medicine ◽

10.1001/archinte.145.4.648 ◽

1985 ◽

Vol 145 (4) ◽

pp. 648-650 ◽

Cited By ~ 4

Author(s):

W. G. Rector

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Direct Measurement ◽

Therapeutic Response ◽

Portal Vein Pressure

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Emergency Management of Bleeding Esophageal Varices: Drugs, Bands or Sleep?

Canadian Journal of Gastroenterology ◽

10.1155/2006/743783 ◽

2006 ◽

Vol 20 (3) ◽

pp. 165-170 ◽

Cited By ~ 12

Author(s):

Brian M Yan ◽

Samuel S Lee

Keyword(s):

Emergency Management ◽

Variceal Bleeding ◽

Pharmacological Treatment ◽

Endoscopic Treatment ◽

Treatment Options ◽

Pharmacological Treatments ◽

Balloon Tamponade ◽

Acute Variceal Bleeding ◽

Endoscopic Band Ligation ◽

Meta Analyses

Variceal bleeding is a severe complication of cirrhosis leading to significant morbidity and mortality. Treatment of acute variceal bleeding has improved dramatically since the era of the mechanical balloon tamponade. These advances include endoscopic band ligation or sclerotherapy, and vasoactive pharmacological options such as somatostatin, octreotide, vasopressin and terlipressin. Evidence from a multitude of clinical trials and meta-analyses comparing endoscopic and pharmacological treatments suggests near equivalence in efficacy for initial hemostasis, mortality and rate of rebleeding. This raises the question of whether on-call gastroenterologists should be performing emergency endoscopic treatment in the middle of the night or start pharmacological treatment and delay endoscopy until optimal patient and working conditions the next morning. The present review analyzes the available comparative data between endoscopic and pharmacological treatment options. Although the literature cannot yet definitively answer the question posed, the authors suggest that delaying endoscopic treatment until the next morning may be the most reasonable practical approach.

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Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032008000100003 ◽

2008 ◽

Vol 45 (1) ◽

pp. 11-16 ◽

Cited By ~ 8

Author(s):

Severino Marcos Borba de Arruda ◽

Victorino Spinelli Toscano Barreto ◽

Fernando José do Amaral

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Variceal Bleeding ◽

Collateral Circulation ◽

Past History ◽

Duplex Sonography ◽

Group I ◽

History Of ◽

Group Ii ◽

Upper Gastrointestinal

BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive patients with hepatosplenic Manson’s schistosomiasis were divided into two groups: group I (six men and six women; mean age 48.7 years) with a past history of bleeding and group II (four men and eight women; mean age 44.7 years) without a past history of upper gastrointestinal bleeding, underwent duplex sonography examination. All patients underwent the same upper gastrointestinal endoscopy and laboratory examinations. Those with signs of mixed chronic liver disease or portal vein thrombosis (three cases) were excluded. RESULTS: Group I showed significantly higher mean portal vein flow velocity than group II (26.36 cm/s vs 17.15 cm/sec). Although, as a whole it was not significant in all forms of collateral vessels (83% vs 100%), there was a significantly higher frequency of splenorenal collateral circulation type in group II compared with group I (17% vs 67%). The congestion index of the portal vein was significantly lower in group I than in group II (0.057 cm vs 0.073 cm/sec). CONCLUSION: Our duplex sonography findings in hepatosplenic Manson’s schistosomiasis support the idea that schistosomotic portal hypertension is strongly influenced by overflow status, and that collateral circulation seems to play an important role in hemodynamic behavior.

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