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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Ten years' follow-up of 472 patients following transjugular intrahepatic portosystemic stent-shunt insertion at a single centre
European Journal of Gastroenterology and Hepatology, Volume 16, No. 1, Year 2004
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Description
Background: Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is increasingly used for the management of portal hypertension. We report on 10 years' experience at a single centre. Methods: Data held in a dedicated database was retrieved on 497 patients referred for TIPSS. The efficacy of TIPSS and its complications were assessed. Results: Most patients were male (59.4%) with alcoholic liver disease (63.6%), and bleeding varices (86.8%). Technical success was achieved in 474 (95.4%) patients. A total of 13.4% of patients bled at portal pressure gradients ≤ 12 mmHg, principally from gastric and ectopic varices. Procedure-related mortality was 1.2%. The mean follow-up period of surviving patients was 33.3 ± 1.9 months. Primary shunt patency rates were 45.4% and 26.0% at 1 and 2 years, respectively, while the overall secondary assisted patency rate was 72.2%. Variceal rebleeding rate was 13.7%, with all episodes occurring within 2 years of TIPSS insertion, and almost all due to shunt dysfunction. The overall mortality rate was 60.4%, mainly resulting from end-stage liver failure (42.5%). Patients who bled from gastric varices had lower mortality than those from oesophageal varices (53.9% versus 61.5%, P < 0.01). The overall rate of hepatic encephalopathy was 29.9% (de novo encephalopathy was 11.5%), with pre-TIPSS encephalopathy being an independent predicting variable. Refractory ascites responded to TIPSS in 72% of cases, although the incidence of encephalopathy was high in this group (36.0%). Conclusions: TIPSS is effective in the management of variceal bleeding, and has a low complication rate. With surveillance, good patency can be achieved. Careful selection of patients is needed to reduce the encephalopathy rate. © 2004 Lippincott Williams & Wilkins.
Authors & Co-Authors
Tripathi, Dhiraj
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Helmy, Ahmed
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Lui, Hock Foong
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Stanley, Adrian J.
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Redhead, Doris N.
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Hayes, Peter Clive
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Statistics
Citations: 81
Authors: 6
Affiliations: 1
Identifiers
Doi:
10.1097/00042737-200401000-00003
ISSN:
0954691X
Research Areas
Noncommunicable Diseases
Study Design
Cohort Study
Participants Gender
Male