UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

IMPACT OF PRE-EMPTIVE TIPS PLACEMENT FOR VARICEAL BLEEDING IN CIRRHOTIC PATIENTS: A REAL-LIFE STUDY IN A TERTIARY REFERRAL CENTER

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

Not sure what you can access? Learn more about account types.

Introduction

Variceal bleeding (VB) is a severe and life-threatening complication in patients with cirrhosis, often leading to significant morbidity and mortality. The Baveno VII consensus recommends early transjugular intrahepatic portosystemic shunt (pre-emptive TIPS, or pTIPS) placement within 72 hours of acute VB in select cirrhotic patients to reduce the risk of re-bleeding and improve survival rates. However, the comparative effectiveness of pTIPS with delayed TIPS or no intervention remains unclear.

Aims & Methods

This study aimed to evaluate the benefits of pTIPS in reducing early relapse of VB, compared to delayed TIPS or no intervention, in a referral center setting. Cirrhotic patients with VB and Child-Pugh Class C<14, or B>7 with active bleeding were retrospectively selected between 2016 and 2022 for two control groups: those who underwent TIPS placement after 7 days (Group A) and those who did not undergo TIPS placement (Group B). Additionally, patients who received pre-emptive TIPS placement between August 2022 and January 2024 were prospectively included.

Results

A total of 47 patients were included (pTIPS group=19, Group A=11, and Group B=17). There were no statistically significant differences between the groups regarding age, gender, aetiology of cirrhosis or Child-Pugh and MELD scores (p>0.05). Early relapse rates (under week 6) were significantly lower in the pTIPS-group (5.3%) versus Groups A (63.6%) and B (35.3%) (p<0.001 and p=0.030, respectively). There were no significant differences in 30-day mortality and length of stay between the pTIPS-group and the whole control group (A+B) (p=0.683 and p=0.269, respectively). Hepatic encephalopathy was significantly lower in the pTIPS-group (after pTIPS placement) compared to Group B (31.6% vs. 81.8%, p=0.008). Readmission rates because of VB were significantly lower in the pTIPS group compared to the whole control group (A+B) (0% vs. 39.3%, p<0.001).

Conclusion

This real-life study demonstrates that pre-emptive TIPS placement significantly reduces the early relapse rates of variceal bleeding in cirrhotic patients compared to delayed TIPS or no intervention. The lower rates of early relapse, decreased readmissions due to VB, and reduced occurrence of hepatic encephalopathy suggest that pTIPS could play a crucial role in lowering morbidity and complications in these patients. While 30-day mortality rates showed no significant differences between the pTIPS group and the control groups, the decreased need for subsequent interventions and hospital readmissions may translate into improved long-term outcomes and reduced healthcare costs. These results support the proactive use of pTIPS in clinical practice for selected patients with acute VB to optimize patient care and outcomes. Further studies with larger sample sizes and longer follow-up periods are needed to validate these findings and further refine the guidelines for pTIPS placement in this context.