Liver Cirrhosis Clinical Trial
Official title:
TIPS vs. NSBB Plus Endotherapy for the Prevention of Variceal Rebleeding in NSBB Non-responders of Primary Prophylaxis
Variceal bleeding (VB) is a life-threatening complication of cirrhosis with a 6-week
mortality of approximately 15%-20%. The 1-year rate of recurrent VB is approximately 60% in
patients without prophylaxis treatment. Therefore, all patients who survive VB must receive
active treatments to prevent rebleeding. Usually, these patients are submitted to rebleeding
prophylaxis with endoscopic band ligation (EBL) combined with non-selective beta-blockers
(NSBB). Transjugular intrahepatic portosystemic shunts (TIPS) are reserved for those who
failed endoscopic plus medical treatment.
A recent meta-analysis comparing combination therapy to monotherapy with EBL or drug therapy
has demonstrated that combination therapy is only marginally more effective than NSBB alone.
This suggests that NSBB is the cornerstone of combination therapy. The lowest rebleeding
rates are observed in patients on secondary prophylaxis who are hepatic venous pressure
gradient (HVPG) responders (defined as a reduction in HVPG below 12 mm Hg or > 20% from
baseline). A recent study demonstrated that patients who have their first episode of variceal
bleeding while on primary prophylaxis with NSBB have an increased risk of further bleeding
and death, despite adding EBL. These patients possibly require alternative treatment
approaches, such as TIPS.
The aim of the present study was to compare the effect of TIPS vs. EBL + NSBB for the
prevention of rebleeding in NSBB non-responder for primary prophylaxis.
n/a
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