TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) FOR VARICEAL BLEEDING IN PORTAL-HYPERTENSION - COMPARISON OF EMERGENCY AND ELECTIVE INTERVENTIONS

Nonsurgical reduction of portal hypertension by transjugular intrahepa tic portosystemic shunt (TIPS) is widely used for prevention of varice al rebleeding (elective TIPS). Information is limited about the value of emergency TIPS for acute variceal bleeding unresponsive to endoscop ic and drug therapy. The aim of the present study was therefore to det ermine whether the effects and complications differ between emergency and elective TIPS in patients with cirrhosis of the liver. TIPS was pe rformed in II patients with acute variceal bleeding unresponsive to en doscopic treatment and 22 patients in stable condition after an episod e of variceal bleeding. Clinical examination, blood sampling, Doppler sonography of TIPS flow, and upper gastrointestinal endoscopy were per formed at days 1, 7, and 30 and at three-month intervals after TIPS. M ean follow-up was 549 (1-987) days. Bleeding was controlled by emergen cy TIPS in 10/11 patients. Probability of survival was not different a fter emergency and elective TIPS (0.73 vs 0.84 at one year). Early reb leeding (less than or equal to 2 weeks) occurred more often after emer gency TIPS (3/11 vs 0/22 patients; P = 0.03), but there was no signifi cant difference in late rebleeding. Occlusion of TIPS was more frequen t after emergency TIPS. Occurrence of TIPS stenoses was identical in b oth groups (4/11 vs 8/22). De novo or deterioration of preexisting hep atic encephalopathy was similar (18% vs 24%; NS). It is concluded that TIPS is effective for control of acute variceal bleeding unresponsive to endoscopic and drug treatment. Early rebleeding and stent occlusio n occurred more often after emergency TIPS. Late rebleeding, complicat ions, and long-term survival did not differ from elective TIPS.