Using transjugular intrahepatic portosystemic shunt as the first-line therapy in secondary prophylaxis of variceal hemorrhage: Using transjugular intrahepatic portosystemic shunt as the first-line therapy in secondary prophylaxis of variceal hemorrhage

BACKGROUND AND AIM: This study aims to evaluate and compare the survival and other portal hypertension-related complications of patients with portal pressure gradient (PPG) >/= 25 mmHg using transjugular intrahepatic portosystemic shunt (TIPS) as the first-line and second-line therapies in secondary prophylaxis of variceal hemorrhage. METHODS: Fifty patients diagnosed with liver cirrhosis were enrolled in this retrospective study, with 35 of whom received TIPS as the first-line therapy in secondary prophylaxis of variceal hemorrhage and 15 of whom as second-line treatment. We observed and analyzed the survival, occurrence of variceal rebleeding and hepatic encephalopathy (HE) of patients in the two groups during the follow up. RESULTS: The technical success rate was 100%. In a median follow-up time of 12 (1-37) and 15 (2-27) months, respectively, significant statistical difference was observed between the first-line group and the second-line group concerning cumulative survival rate (94.3% vs 66.7%, log-rank P = 0.01). But that was not the case when it comes to the cumulative rate of variceal rebleeding (8.6% vs 26.7%, log-rank P = 0.164) and HE (22.9% vs 20.0%, log-rank P = 0.793). And multivariate analysis indicated that group assignment (hazard ratio = 8.250, 95% confidence interval = 1.383-49.213, P = 0.021) was the only predictor of survival. Interestingly, we found that spleen diameter (hazard ratio = 0.578, 95% confidence interval = 0.393-0.849, P = 0.005) could be regarded as independent predictor of the occurrence of HE. CONCLUSIONS: For patients with PPG >/= 25 mmHg who have recovered from an episode of acute esophageal variceal hemorrhage, utilizing TIPS as the first-line therapy to prevent rebleeding is demonstrated effective in improving the survival and therefore should be recommended to a wider range of clinical practice.