A COMPARISON BETWEEN GASTRIC AND ESOPHAGEAL VARICEAL HEMORRHAGE TREATED WITH TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT (TIPSS)

Background: Transjugular intrahepatic portosystemic stent-shunts (TIPS S) are becoming widely used in the management of oesophageal variceal haemorrhage (OVH). Their place in the treatment of gastric variceal ha emorrhage (GVH), a condition with a traditionally poor prognosis, rema ins unclear. The aims of our study were to compare portal haemodynamic s and patient outcome in patients undergoing TIPSS for either GVH or O VH. Patients and Methods: 106 consecutive patients undergoing TIPSS at our institution for either GVH (32 patients) or OVH (74 patients) wer e studied. The groups were similar with regard to patient age, aetiolo gy and severity of liver disease and number of procedures carried out as an emergency (34.4% vs. 36.5%). Episodes of shunt insufficiency, re bleeding, encephalopathy and other clinical sequela were recorded. Mea n follow-up was similar in both patient groups (14.2 vs. 12.1 months). Results: Baseline portocaval pressure gradient was lower in patients with GVH compared with those with OVH (13.0+/-0.9 mmHg vs. 19.0+/-0.6 mmHg) (P < 0.001). Rates of variceal rebleeding, encephalopathy and sh unt insufficiency during follow-up were similar in both groups and the re was no difference in survival.Conclusion: Patients with GVH had mar kedly lower portocaval pressure gradients than those with OVH, but shu nt and clinical complications and survival were similar during follow- up, TIPSS appears to be an effective treatment for GVH and should be c ompared with endoscopic or surgical techniques in controlled trials.