Distal Splenorenal Shunt Versus Transjugular Intrahepatic Portal Systematic Shunt for Variceal Bleeding: A Randomized Trial

J. Michael Henderson, Thomas D. Boyer, Michael H. Kutner, John R. Galloway, Layton F. Rikkers, Lennox J Jeffers, Kareem Abu-Elmagd, Jason Connor

Research output: Contribution to journalArticle

185 Citations (Scopus)

Abstract

Background & Aims: Variceal bleeding refractory to medical treatment with β-blockers and endoscopic therapy can be managed by variceal decompression with either surgical shunts or transjugular intrahepatic portal systemic shunts (TIPS). This prospective randomized trial tested the hypothesis that patients receiving distal splenorenal shunts (DSRS) would have significantly lower rebleeding and encephalopathy rates than TIPS in management of refractory variceal bleeding. Methods: A prospective randomized controlled clinical trial at 5 centers was conducted. One hundred forty patients with Child-Pugh class A and B cirrhosis and refractory variceal bleeding were randomized to DSRS or TIPS. Protocol and event follow-up for 2-8 years (mean, 46 ± 26 months) for primary end points of variceal bleeding and encephalopathy and secondary end points of death, ascites, thrombosis and stenosis, liver function, need for transplant, quality of life, and cost were evaluated. Results: There was no significant difference in rebleeding (DSRS, 5.5%; TIPS, 10.5%; P = .29) or first encephalopathy event (DSRS, 50%; TIPS, 50%). Survival at 2 and 5 years (DSRS, 81% and 62%; TIPS, 88% and 61%, respectively) were not significantly different (P = .87). Thrombosis, stenosis, and reintervention rates (DSRS, 11%; TIPS, 82%) were significantly (P < .001) higher in the TIPS group. Ascites, need for transplant, quality of life, and costs were not significantly different. Conclusions: DSRS and TIPS are similarly efficacious in the control of refractory variceal bleeding in Child-Pugh class A and B patients. Reintervention is significantly greater for TIPS compared with DSRS. Because both procedures have equivalent outcomes, the choice is dependent on available expertise and ability to monitor the shunt and reintervene when needed.

Original languageEnglish
Pages (from-to)1643-1651
Number of pages9
JournalGastroenterology
Volume130
Issue number6
DOIs
StatePublished - Jun 1 2006

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Surgical Splenorenal Shunt
Hemorrhage
Brain Diseases
Ascites
Pathologic Constriction
Thrombosis
Quality of Life
Transplants
Costs and Cost Analysis
Decompression
Fibrosis
Randomized Controlled Trials

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Henderson, J. M., Boyer, T. D., Kutner, M. H., Galloway, J. R., Rikkers, L. F., Jeffers, L. J., ... Connor, J. (2006). Distal Splenorenal Shunt Versus Transjugular Intrahepatic Portal Systematic Shunt for Variceal Bleeding: A Randomized Trial. Gastroenterology, 130(6), 1643-1651. https://doi.org/10.1053/j.gastro.2006.02.008

Distal Splenorenal Shunt Versus Transjugular Intrahepatic Portal Systematic Shunt for Variceal Bleeding : A Randomized Trial. / Henderson, J. Michael; Boyer, Thomas D.; Kutner, Michael H.; Galloway, John R.; Rikkers, Layton F.; Jeffers, Lennox J; Abu-Elmagd, Kareem; Connor, Jason.

In: Gastroenterology, Vol. 130, No. 6, 01.06.2006, p. 1643-1651.

Research output: Contribution to journalArticle

Henderson, JM, Boyer, TD, Kutner, MH, Galloway, JR, Rikkers, LF, Jeffers, LJ, Abu-Elmagd, K & Connor, J 2006, 'Distal Splenorenal Shunt Versus Transjugular Intrahepatic Portal Systematic Shunt for Variceal Bleeding: A Randomized Trial', Gastroenterology, vol. 130, no. 6, pp. 1643-1651. https://doi.org/10.1053/j.gastro.2006.02.008
Henderson, J. Michael ; Boyer, Thomas D. ; Kutner, Michael H. ; Galloway, John R. ; Rikkers, Layton F. ; Jeffers, Lennox J ; Abu-Elmagd, Kareem ; Connor, Jason. / Distal Splenorenal Shunt Versus Transjugular Intrahepatic Portal Systematic Shunt for Variceal Bleeding : A Randomized Trial. In: Gastroenterology. 2006 ; Vol. 130, No. 6. pp. 1643-1651.
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abstract = "Background & Aims: Variceal bleeding refractory to medical treatment with β-blockers and endoscopic therapy can be managed by variceal decompression with either surgical shunts or transjugular intrahepatic portal systemic shunts (TIPS). This prospective randomized trial tested the hypothesis that patients receiving distal splenorenal shunts (DSRS) would have significantly lower rebleeding and encephalopathy rates than TIPS in management of refractory variceal bleeding. Methods: A prospective randomized controlled clinical trial at 5 centers was conducted. One hundred forty patients with Child-Pugh class A and B cirrhosis and refractory variceal bleeding were randomized to DSRS or TIPS. Protocol and event follow-up for 2-8 years (mean, 46 ± 26 months) for primary end points of variceal bleeding and encephalopathy and secondary end points of death, ascites, thrombosis and stenosis, liver function, need for transplant, quality of life, and cost were evaluated. Results: There was no significant difference in rebleeding (DSRS, 5.5{\%}; TIPS, 10.5{\%}; P = .29) or first encephalopathy event (DSRS, 50{\%}; TIPS, 50{\%}). Survival at 2 and 5 years (DSRS, 81{\%} and 62{\%}; TIPS, 88{\%} and 61{\%}, respectively) were not significantly different (P = .87). Thrombosis, stenosis, and reintervention rates (DSRS, 11{\%}; TIPS, 82{\%}) were significantly (P < .001) higher in the TIPS group. Ascites, need for transplant, quality of life, and costs were not significantly different. Conclusions: DSRS and TIPS are similarly efficacious in the control of refractory variceal bleeding in Child-Pugh class A and B patients. Reintervention is significantly greater for TIPS compared with DSRS. Because both procedures have equivalent outcomes, the choice is dependent on available expertise and ability to monitor the shunt and reintervene when needed.",
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T2 - A Randomized Trial

AU - Henderson, J. Michael

AU - Boyer, Thomas D.

AU - Kutner, Michael H.

AU - Galloway, John R.

AU - Rikkers, Layton F.

AU - Jeffers, Lennox J

AU - Abu-Elmagd, Kareem

AU - Connor, Jason

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AB - Background & Aims: Variceal bleeding refractory to medical treatment with β-blockers and endoscopic therapy can be managed by variceal decompression with either surgical shunts or transjugular intrahepatic portal systemic shunts (TIPS). This prospective randomized trial tested the hypothesis that patients receiving distal splenorenal shunts (DSRS) would have significantly lower rebleeding and encephalopathy rates than TIPS in management of refractory variceal bleeding. Methods: A prospective randomized controlled clinical trial at 5 centers was conducted. One hundred forty patients with Child-Pugh class A and B cirrhosis and refractory variceal bleeding were randomized to DSRS or TIPS. Protocol and event follow-up for 2-8 years (mean, 46 ± 26 months) for primary end points of variceal bleeding and encephalopathy and secondary end points of death, ascites, thrombosis and stenosis, liver function, need for transplant, quality of life, and cost were evaluated. Results: There was no significant difference in rebleeding (DSRS, 5.5%; TIPS, 10.5%; P = .29) or first encephalopathy event (DSRS, 50%; TIPS, 50%). Survival at 2 and 5 years (DSRS, 81% and 62%; TIPS, 88% and 61%, respectively) were not significantly different (P = .87). Thrombosis, stenosis, and reintervention rates (DSRS, 11%; TIPS, 82%) were significantly (P < .001) higher in the TIPS group. Ascites, need for transplant, quality of life, and costs were not significantly different. Conclusions: DSRS and TIPS are similarly efficacious in the control of refractory variceal bleeding in Child-Pugh class A and B patients. Reintervention is significantly greater for TIPS compared with DSRS. Because both procedures have equivalent outcomes, the choice is dependent on available expertise and ability to monitor the shunt and reintervene when needed.

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