Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study
Por:
Hernandez-Gea, V, Procopet, B, Giraldez, A, Amitrano, L, Villanueva, C, Thabut, D, Ibanez-Samaniego, L, Silva-Junior, G, Martinez, J, Genesca, J, Bureau, C, Trebicka, J, Llop, E, Laleman, W, Palazon, J, Castellote, J, Rodrigues, S, Gluud, L, Ferreira, C, Barcelo, R, Canete, N, Rodriguez, M, Ferlitsch, A, Mundi, J, Gronbaek, H, Hernandez-Guerra, M, Sassatelli, R, Dell'Era, A, Senzolo, M, Abraldes, J, Romero-Gomez, M, Zipprich, A, Casas, M, Masnou, H, Primignani, M, Krag, A, Nevens, F, Calleja, J, Jansen, C, Robic, M, Conejo, I, Catalina, M, Albillos, A, Rudler, M, Alvarado, E, Guardascione, M, Tantau, M, Bosch, J, Torres, F, Garcia-Pagan, J, Fischer, P, Stefanescu, H, Pop, A, Laursen, S, Turon, F, Baiges, A, Berbel, C, Cerda, E, Tellez, L, Allegretti, G, Macedo, G, Haldrup, D, Santos, P, Moura, M, Reis, D, Meireles, L, Sousa, P, Alexandrino, P, Navascues, C, Augustin, S, La Mura, V, Banares, R, Diaz, R, Gomez, M, Ripoll, C and Int Variceal Bleeding
Publicada:
1 ene 2019
Ahead of Print:
10 dic 2018
Resumen:
Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.
Filiaciones:
Hernandez-Gea, V:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Procopet, B:
Reg Inst Gastroenterol & Hepatol Octavian Fodor, Hepatol Dept, Cluj Napoca, Romania
Iuliu Hatieganu Univ Med & Pharm, Med Clin 3, Cluj Napoca, Romania
Giraldez, A:
Univ Hosp Virgen del Rocio, Clin Management Unit Digest Dis, Seville, Spain
Amitrano, L:
Osped A Cardarelli, Gastroenterol Unit, Naples, Italy
Villanueva, C:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Santa Creu & Sant Pau, Serv Patol Digest, Barcelona, Spain
CIBERehd, Barcelona, Spain
Thabut, D:
Grp Hosp Pitie Salpetriere Charles Foix, Paris, France
Ibanez-Samaniego, L:
Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest Gregorio Maranon, IiSGM, CIBERehd, Barcelona, Spain
Silva-Junior, G:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Martinez, J:
Univ Alcala De Henares, Hosp Univ Ramon & Cajal, Dept Gastroenterol, CIBERehd,IRYCIS, Madrid, Spain
Genesca, J:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
CIBERehd, Barcelona, Spain
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Vall dHebron Inst Res VHIR, Liver Unit, Barcelona, Spain
Bureau, C:
Univ Toulouse, Dept Hepatogastroenterol, CHU Toulouse, Purpan Hosp,INSERM,U858, Toulouse, France
Trebicka, J:
Univ Bonn, Dept Internal Med 1, Bonn, Germany
European Fdn Study Chron Liver Failure EF Clif, Barcelona, Spain
Inst Bioengn Catalonia, Barcelona, Spain
Odense Univ Hosp, Dept Gastroenterol & Hepatol, Odense, Denmark
Llop, E:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Madrid, CIBERehd, Liver Unit, Hosp Univ Puerta de Hierro, Madrid, Spain
Laleman, W:
Univ Leuven, Dept Liver & Biliopancreat Disorders, Leuven, Belgium
:
Hosp Gen Univ Alicante, Alicante, Spain
Castellote, J:
Univ Barcelona, Hosp Univ Bellvitge, Dept Gastroenterol, Hepatol Unit,IDIBELL, Barcelona, Spain
Rodrigues, S:
Ctr Hosp Sao Joao, Dept Gastroenterol & Hepatol, Porto, Portugal
Gluud, L:
Univ Copenhagen, Hvidovre Univ Hosp, Fac Hlth & Med Sci, Gastrounit,Med Div, Copenhagen, Denmark
Ferreira, C:
Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal
Barcelo, R:
Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer, Med Stat Core Facil, Barcelona, Spain
Canete, N:
Univ Autonoma Barcelona, IMIM Hosp Mar Med Res Inst, Hosp Mar, Liver Sect,Gastroenterol Dept, Barcelona, Spain
:
Hosp Cent Asturias, Dept Gastroenterol, Oviedo, Spain
Ferlitsch, A:
Med Univ Vienna, Div Gastroenterol & Hepatol, Dept Internal Med 3, Vienna, Austria
Mundi, J:
Univ Hosp San Cecilio, Dept Gastroenterol, Granada, Spain
Gronbaek, H:
Aarhus Univ Hosp, Dept Gastroenterol & Hepatol, Aarhus, Denmark
Hernandez-Guerra, M:
Univ Hosp Canary Isl, Dept Gastroenterol, Tenerife, Spain
Sassatelli, R:
Arcispedale Santa Maria Nuova IRCCS, Unit Gastroenterol & Digest Endoscopy, Reggio Emilia, Italy
Dell'Era, A:
Univ Milan, Dept Clin & Biomed Sci, Asst Fatebenefratelli Sacco, Gastroenterol Unit, Milan, Italy
Senzolo, M:
Univ Hosp Padua, Dept Surg Oncol & Gastroenterol, Multivisceral Transplant Unit, Gastroenterol, Padua, Italy
Abraldes, J:
Univ Alberta, Cegiir, Cirrhosis Care Clin, Div Gastroenterol,Liver Unit, Edmonton, AB, Canada
Romero-Gomez, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Univ Valme, CIBERehd, Unidad Hepatol, Seville, Spain
Zipprich, A:
Martin Luther Univ Halle Wittenberg, Dept Internal Med 1, Halle, Saale, Germany
Casas, M:
Univ Autonoma Barcelona, Hosp Sabadell, Digest Dis Dept, Hepatol Unit, Sabadell, Spain
Masnou, H:
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Badalona, Spain
Primignani, M:
Univ Milan, IRCCS Ca Granda Maggiore Hosp Fdn, Div Gastroenterol & Hepatol, Milan, Italy
Krag, A:
Odense Univ Hosp, Dept Gastroenterol & Hepatol, Odense, Denmark
Nevens, F:
Univ Leuven, Dept Liver & Biliopancreat Disorders, Leuven, Belgium
Calleja, J:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Madrid, CIBERehd, Liver Unit, Hosp Univ Puerta de Hierro, Madrid, Spain
Jansen, C:
Univ Bonn, Dept Internal Med 1, Bonn, Germany
Robic, M:
Univ Toulouse, Dept Hepatogastroenterol, CHU Toulouse, Purpan Hosp,INSERM,U858, Toulouse, France
Conejo, I:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
CIBERehd, Barcelona, Spain
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Vall dHebron Inst Res VHIR, Liver Unit, Barcelona, Spain
Catalina, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest Gregorio Maranon, IiSGM, CIBERehd, Barcelona, Spain
Albillos, A:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Alcala De Henares, Hosp Univ Ramon & Cajal, Dept Gastroenterol, CIBERehd,IRYCIS, Madrid, Spain
Rudler, M:
Grp Hosp Pitie Salpetriere Charles Foix, Paris, France
Alvarado, E:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Santa Creu & Sant Pau, Serv Patol Digest, Barcelona, Spain
CIBERehd, Barcelona, Spain
Guardascione, M:
Osped A Cardarelli, Gastroenterol Unit, Naples, Italy
Tantau, M:
Reg Inst Gastroenterol & Hepatol Octavian Fodor, Hepatol Dept, Cluj Napoca, Romania
Iuliu Hatieganu Univ Med & Pharm, Med Clin 3, Cluj Napoca, Romania
Bosch, J:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Bern Univ, Swiss Liver Ctr, Inselspital, Bern, Switzerland
Torres, F:
Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer, Med Stat Core Facil, Barcelona, Spain
Univ Autonoma Barcelona, Fac Med, Biostat Unit, Barcelona, Spain
Garcia-Pagan, J:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Fischer, P:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Stefanescu, H:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Pop, A:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Laursen, S:
Odense Univ Hosp, Dept Gastroenterol & Hepatol, Odense, Denmark
Turon, F:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Baiges, A:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Berbel, C:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Cerda, E:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Tellez, L:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Allegretti, G:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer, Barcelona Hepat Hemodynam Lab, Liver Unit,Hosp Clin,IMDIM, Barcelona, Spain
Macedo, G:
Ctr Hosp Sao Joao, Dept Gastroenterol & Hepatol, Porto, Portugal
Haldrup, D:
Aarhus Univ Hosp, Dept Gastroenterol & Hepatol, Aarhus, Denmark
Santos, P:
Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal
Moura, M:
Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal
Reis, D:
Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal
Meireles, L:
Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal
Sousa, P:
Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal
Alexandrino, P:
Ctr Hosp Lisboa Norte, Hosp Santa Maria, Serv Gastrenterol & Hepatol, Lisbon, Portugal
Navascues, C:
Hosp Cent Asturias, Dept Gastroenterol, Oviedo, Spain
Augustin, S:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Vall dHebron Inst Res VHIR, Liver Unit, Barcelona, Spain
La Mura, V:
Univ Milan, IRCCS Ca Granda Maggiore Hosp Fdn, Div Gastroenterol & Hepatol, Milan, Italy
Banares, R:
Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest Gregorio Maranon, IiSGM, CIBERehd, Barcelona, Spain
Diaz, R:
Hosp Gen Univ Gregorio Maranon, Serv Med Aparato Digest Gregorio Maranon, IiSGM, CIBERehd, Barcelona, Spain
Gomez, M:
Univ Autonoma Madrid, CIBERehd, Liver Unit, Hosp Univ Puerta de Hierro, Madrid, Spain
Ripoll, C:
Martin Luther Univ Halle Wittenberg, Dept Internal Med 1, Halle, Saale, Germany
Green Published
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