Comparative efficacy of pre-emptive TIPS and elective TIPS in EGVB patients with cirrhosis: A single-center retrospective study.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is the main method to prevent the rebleeding of esophagogastric varices. Many studies have demonstrated that pre-emptive TIPS (p-TIPS) is superior to medicine combined with endoscopic standard therapy in the efficacy of high-risk patients, but very few relevant studies reported whether p-TIPS is more effective than elective TIPS. This study aims to compare the efficacy and prognosis of p-TIPS and elective TIPS for the treatment of esophagogastric variceal bleeding (EGVB) patients with cirrhosis.

Methods: In this retrospective study, clinical data of 92 patients with cirrhosis who accepted TIPS treatment after EGVB of cirrhosis were collected. According to the different times of TIPS, the patients were divided into the p-TIPS group and the elective TIPS group. The following information is documented: clinical manifestations and laboratory examination at 1, 3, and 6 months after the operation, survival state, the rates of rebleeding at 6 weeks and 6 months, and postoperative complications and serious adverse events during follow-up.

Results: The Child-Pugh score (P = 0.002) and MELD score (P = 0.006) in the p-TIPS group were significantly lower than those in the elective TIPS group in the 6th month after treatment. The rate of no gastric coronary vein embolization in the p-TIPS group was higher than in the elective TIPS group (P = 0.034). The hospitalized days (P < 0.001) and hospitalized costs (P < 0.001) were significantly lower in the p-TIPS group than in the elective TIPS group. No significant differences were observed between the two groups concerning rebleeding, overt hepatic encephalopathy, ascites, complications, and serious adverse events, occurrence.

Conclusion: The p-TIPS contributes to liver function recovery and enhances patient survival benefits at 6-months postoperation in the treatment of EGVB compared with elective TIPS, without increasing the incidence of complications and adverse events.