Transjugular intrahepatic portosystemic shunts (TIPS) can work as a first line treatment in selected high-risk patients with bleeding oesophageal varices, a new trial suggests.
Patients included in the study had severe cirrhosis and bleeding oesophageal varices. They were treated initially with vasoactive drugs and endoscopic banding or sclerotherapy and had a high risk of rebleeding. Patients randomised to TIPS (n=32) had a shunt placed within 72 hours of their first endoscopy.
Compared with optimal drug treatment and repeated endoscopic band ligation, early TIPS prevented rebleeding or treatment failure (1/32 v 14/31; P=0.001) and reduced mortality (4/32 v 12/31; P=0.01), without increasing the risk of hepatic encephalopathy. TIPS was also associated with better survival at six weeks (97% vs 67%) and...
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