Preemptive TIPS Promising for Fundal Variceal Bleeding
TOPLINE:
In sufferers with cirrhosis and acute fundal variceal bleeding, the utilize of preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) with a lined stent interior 72 hours of preliminary bleeding resulted in superior outcomes, with the next likelihood of sufferers being free of loss of life or rebleeding at 1 year than these using identical old treatment.
METHODOLOGY:
- Researchers performed a randomised trial across 17 tertiary centres in France to examine two suggestions for stopping rebleeding of non-form 1 gastro-oesophageal varices.
- They integrated 101 sufferers with cirrhosis and acute fundal variceal bleeding (imply age, 58.2 years; 80% males) from January 3, 2019, to February 25, 2023, who carried out preliminary haemostasis with endoscopic glue injection for in any case 12 hours.
- Sufferers were randomly assigned to both safe p-TIPS interior 72 hours of the preliminary endoscopic glue injection (n = 47) or continue with on-anticipate glue obliteration combined with non-selective beta blockers (n = 54).
- The most most primary composite endpoint used to be all-cause mortality or clinically famous rebleeding, outlined as recurrent melena or haematemesis requiring hospitalisation or blood transfusion or causing a 3 g/dL descend in haemoglobin, interior 1 year from the preliminary haemostasis. Analyses were performed within the modified draw-to-treat population.
TAKEAWAY:
- The 1-year likelihood of being free from loss of life or rebleeding used to be greater within the p-TIPS neighborhood than within the glue obliteration and non-selective beta-blocker neighborhood (77% vs 37%; hazard ratio, 0.25; P < .0001).
- The overall survival did no longer differ vastly between the 2 teams; then yet again, 37% of sufferers within the glue obliteration and non-selective beta-blocker neighborhood required TIPS after a median of 25 days. The cumulative incidence of hepatic encephalopathy at 1 year used to be 35% within the p-TIPS neighborhood and 32% within the glue obliteration and non-selective beta-blocker neighborhood.
- Complications linked to glue injection came about in 22 procedures, including 13 bleeding episodes, eight glue migrations (three within the p-TIPS neighborhood and five within the glue obliteration neighborhood), and one case of cardiac decompensation within the p-TIPS neighborhood.
- The desire of sufferers who skilled any adverse or severe adverse event did no longer differ vastly between the teams, and no deaths were thought to be linked to the treatment.
IN PRACTICE:
“The outcomes of the most up-to-date peek strongly crimson meat up the utilize of p-TIPS within the management of acute gastric variceal bleeding and add a additional argument in favour of TIPS, which improves prognosis by successfully treating the haemodynamic issues linked to cirrhosis,” the authors of the peek wrote. “In sufferers with cirrhosis and bleeding from fundal varices, p-TIPS with a lined stent is linked to markedly diminished loss of life or rebleeding and must always because of this of this fact be thought to be as a indispensable-line treatment,” they added.
SOURCE:
This peek used to be led by Jean-Paul Cervoni, MD, Carrier d’Hépatologie et de Soins Intensifs, CHU Besançon, Besançon, France. It used to be printed online on June 12, 2025, in The Lancet Gastroenterology & Hepatology.
LIMITATIONS:
A dinky sample size precluded definitive subgroup analyses (eg, variceal form). An overrepresentation of alcohol-linked cirrhosis may bear restricted the applicability of the findings to other aetiologies. Eight sufferers within the p-TIPS neighborhood were handled previous the 72-hour window.
DISCLOSURES:
This peek used to be funded by the French Ministry of Health. Two authors reported receiving payment for lectures and one creator reported receiving consulting charges from Gore.
This text used to be created using a total lot of editorial tools, including AI, as fragment of the formula. Human editors reviewed this explain before e-newsletter.
