TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC S HUNTS IN PATIENTS WITH ACTIVE AND REFRACTORY VARICEAL BLEEDING - A REPORT OF 11 CASES

Objective. - The aim of this study was to assess the feasibility and e fficacy of transjugular intrahepatic portosystemic shunts for refracto ry variceal bleeding, uncontrolled by sclerotherapy or endoscopic liga tion. Methods. - 11 patients (mean age 52 years) with cirrhosis admitt ed for refractory haemorrhage from ruptured oesophageal varices were i ncluded in this study. Eight patients were Child-Pugh class C. All pat ients were actively bleeding. Results. - All the procedures were succe ssful Variceal haemorrhage stopped within 24 h. There was no mortality during the procedure. Early complications such as rebleeding (18 %) a nd thrombosis (18 %) occurred. Thirty days mortality was 27 %. Follow- up in the 8 surviving patients was 19.5 +/- 8 months. Three patients d eveloped recurrent bleeding, from non-variceal sources in 2. In 4 surv iving patients, occlusion of the shunt was treated with dilatation or insertion of a second stent. The incidence of hepatic encephalopathy w as 25 %. Five patients subsequently underwent liver transplantation. A mong the 3 patients ineligible for transplantation, one died of hepato cellular carcinoma after 10 months. The 2 others were active after 19 and 25 months, respectively. Conclusion - These results suggest that t ransjugular intrahepatic portosystemic shunt is a safe and effective p rocedure of portal decompression in patients with refractory variceal bleeding. Prospective trials comparing this percutaneous procedure and surgical treatment are required.