A RANDOMIZED TRIAL COMPARING TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT WITH VARICEAL BAND LIGATION IN THE PREVENTION OF REBLEEDING FROM ESOPHAGEAL-VARICES

The aim of this study was to compare transjugular intrahepatic portosy stemic stent-shunt (TIPSS) with variceal band ligation (VBL) in the se condary prophylaxis of esophageal variceal hemorrhage in patients with cirrhosis. Fifty-eight patients with cirrhosis who presented with the first episode of esophageal variceal hemorrhage were randomized to TI PSS (31) or VBL (27), 24 hours after control of bleeding, Shunt functi on was assessed after 1 month and then at 6 monthly intervals thereaft er, VBL was performed weekly until variceal eradication, and then at 3 months, 6 months, and yearly thereafter, Mean follow-up in the TIPSS group was 15.7 (+/- 10.2) months; in the VBL group, it was 16.8 (+/- 1 0.9) months, Results for rebleeding and mortality were analyzed on an intention-to-treat basis and using the Kaplan-Meier method, The freque ncy and the severity of variceal rebleeding was significantly lower in the TIPSS group (9.8%), compared with the VBL group (51.9%) (P < .000 6), Although mortality rates were not significantly different, 8 of th e patients who rebled in the VBL group required TIPSS therapy for unco ntrolled bleeding. No significant differences were found in the freque ncy of other complications such as encephalopathy and sepsis. Patients in the VBL group required significantly greater time in the intensive care unit during the period of this study (< 0.03), The total direct cost of treatment incurred was pound 1,373 ($2,200) per patient, the c ost being less in the patients treated with TIPSS compared with VBL. T he results of this study show that TIPSS is superior to VBL for the se condary prophylaxis of variceal hemorrhage in patients with cirrhosis.