Application of Digestive Endoscopic Sequential TIPS Therapy in the Treat-ment of Esophagoegastric Variceal Bleeding in Patients with Liver Cirrho-sis

LIU Siqi; CHEN Lei; SHI Chengyi; LIU Kunyi; ZHANG Xueqiang; WANG Na

doi:10.3969/j.issn.2095-3097.2024.01.011

Abstract：Objective To evaluate the safety and efficacy of endoscopic sequential transjugular intrahepatic portal shunt(TIPS)in the treatment of acute esophagogastric variceal bleeding(EGVB)in patients with liver cirrhosis.Methods Thirty-one cirrhosis patients with acute EGVB who received endoscopic sequential TIPS from September 2019 to March 2021 were classified as the endoscopic sequential TIPS group,and 46 patients who received endoscopic sequential therapy alone were classified as the endoscopic sequential TIPS group.The change of portal vein pressure gradient in the endoscopic sequen-tial TIPS group was observed,and the improvement degree of varicose veins and liver function of the two groups,as well as the rate of rebleeding and the incidence of hepatic encephalopathy at 1,3,6 and 12 months after surgery,were compared.The survival of the two groups was analyzed after follow-up.Results The portal vein pressure gradient in the endoscopic sequen-tial TIPS group after operation was lower than that before operation(P<0.01).Alanine aminotransferase(ALT)and aspar-tate aminotransferase(AST)in the endoscopic sequential TIPS group at 1 month after operation were higher than those at other time points(P<0.05),and began to decrease at 3 months after operation.The postoperative serum bilirubin levels were ele-vated,and direct bilirubin(DBIL)and indirect bilirubin(IBIL)reached the peak at 3 months after operation,and gradually decreased at 6 months after operation(P<0.05)in the endoscopic sequential TIPS group.ALT and AST were lower and ALB was higher in the sequential endoscopic group at 3 and 7 days after operation than those before operation(P<0.05),while the level of TBIL at 1 month after operation was lower than that before operation(P<0.05).The DBIL at 1 week and 1 and 3 months after operation was lower than that before operation(P<0.05).There was no significant difference in the eradica-tion rate of varicose veins between the two groups(P>0.05).The rate of rebleeding at 6 and12 months after operation in the sequential TIPS group was lower than that in the sequential TIPS group(P<0.01).There was no significant difference in the incidence of postoperative hepatic encephalopathy and 1-year survival rate between the two groups(P>0.05).Conclusion TIPS can reduce the portal vein pressure,and the eradication rate of varicose veins is comparable to that of sequential endo-scopic therapy,but it can effectively reduce the rate of rebleeding without decreasing the survival rate and increasing the inci-dence of hepatic encephalopathy.Endoscopic sequential TIPS is safe and effective in the treatment of EVGB in patients with liver cirrhosis.