TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT (TIPSS) FOR VARICEAL HEMORRHAGE - INITIAL RESULTS IN 28 PATIENTS

Background: Endoscopic sclerotherapy is an effective form of treatment of bleeding varices in patients with cirrhosis. However, the mortalit y in patients who rebleed is high. Recently, transjugular intrahepatic portosystemic stent-shunt (TIPSS) has been developed as an alternativ e to surgical shunt formation in patients who have failed sclerotherap y. Aim: To review the early experience with TIPSS at a teaching hospit al. Methods: Twenty-eight patients underwent TIPSS on 30 occasions bet ween September 1991 and June 1993 for bleeding oesophageal or gastric varices. The majority had alcoholic liver disease. Results: TIPSS was performed successfully in all patients. Immediate control of bleeding was achieved, but one patient rebled within 24 hours. Complications re lated to the procedure occurred in 30%, but no patient died from these . Thirty-day mortality was 11% (three of 28), two patients dying from progressive liver failure and one from sepsis. A further three patient s died from six weeks to two months following TIPSS, due to liver fail ure in one, spontaneous bacterial peritonitis in the second and in the third after a fall. This represents an overall mortality of 21%. Thre e patients have rebled at mean follow-up of 11.3 months. One of these had repeat TIPSS while the other two had balloon dilatation of the ste nt with control of bleeding. Four patients developed mild chronic ence phalopathy which was readily controlled with medical therapy. Conclusi ons: TIPSS is an effective means for control of bleeding from oesophag eal and/or gastric varices not responding to other methods. Further fo llow-up is required with regard to rates of rebleeding, encephalopathy and survival.