TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT AS A RESCUE TREATMENT AFTER SCLEROTHERAPY FAILURE IN VARICEAL BLEEDING

Background: Variceal bleeding carries high early mortality, especially after failure of conventional treatments such as endoscopic injection therapy. The present study analyses the efficacy of transjugular intr ahepatic portosystemic stent shunt (TIPS) in cirrhotic patients after failure of sclerotherapy for variceal breeding. Methods: Twenty-four c onsecutive patients underwent TIPS in this indication. Results: The pr ocedure was successful in all patients, with reduction of size or disa ppearance of varices in 96% of them. Four patients (17%) developed enc ephalopathy and six (25%) rebled during the follow-up period (median 5 months; range 1-19). Thirty-day mortality was only 17% and 29% during the followup period. Deaths were mainly due to liver failure, especia lly after procedures performed in emergency. Significant decrease in l iver function was observed in the days following the procedure. To mai ntain long-term patency of the shunt, revision was required in nine pa tients (38%). Conclusions: TIPS seems to be a promising salvage therap eutic procedure after failed sclerotherapy, but this needs to be addre ssed in controlled trials.