Do gastric and oesophageal varices bleed at different portal pressures andis TIPS an effective treatment?

Background It has been suggested that gastric varices bleed at lower portos ystemic pressure gradients (PSPG) than oesophageal varices and that transju gular intrahepatic portosystemic shunt (TIPS) is a particularly effective t reatment in these patients. Aims. This study was undertaken to assess the d ifference in PSPG measured at the time of TIPS insertion between patients b leeding from gastric and those bleeding from oesophageal varices. Rebleedin g and mortality rates between the two groups were also compared. Patients a nd methods: In a live year period, 64 patients (36 males and 28 females) un dergoing TIPS for acute variceal bleeding had PSPG measured at the time of TIPS insertion. 12 patients underwent TIPS for gastric variceal haemorrhage (GVH) and 52 for oesophageal variceal haemorrhage (OVH). The median age wa s 53 years and 40/64 patients (63%) had alcoholic liver disease. The median Child's Pugh score was 8 for GVH and 9 for OVH patients. Median follow up was 75 weeks. Results: There was no significant difference in median PSPG b etween patients with GVH, 21 mmHg (range 15-30 mmHg) and OVH, 22 mmHg (rang e 12-45 mmHg). Following TIPS, PSPG was 8.5 mmHg (range 3-11 mmHg) and 9 mm Hg (range 4-20 mmHg) in GVH and OVH patients respectively Rebleeding occurr ed in 2/12 (16%) GVH patients and 12/52 (23%) OVH patients (p=1.0). Mortali ty during follow up was 25% (4/12) in the GVH and 25% (13/52) in the OVH pa tients. Conclusion: In this study, there was no difference between the pres sures at which gastric and oesophageal varices bled. Rebleeding and mortali ty rates were similar in the two groups. TIPS is equally effective in the t reatment of both oesophageal and gastric variceal haemorrhage.