Long-term outcomes of early transjugular intrahepatic portosystemic shunts in patients with acute variceal bleeding and cirrhosis.

Background: Early transjugular intrahepatic portosystemic shunts (TIPS) is a therapeutic option for acute variceal bleeding (AVB), offering a low risk of rebleeding. However, the long-term outcomes of early TIPS remain unclear.

Aim: To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.

Methods: We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023. The primary outcome was overall survival (OS).

Results: A total of 37 patients with AVB underwent early TIPS, while 65 patients received standard treatment. Compared with the standard treatment group, the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower (10.8% vs 50.8%, P < 0.001). Over a median follow-up of 46 months, no statistically significant differences were observed in terms of OS (P = 0.507). The presence of comorbidities was identified as an independent predictor of OS (adjusted hazard ratio = 3.81; 95% confidence interval: 1.16-12.46). Notably, new or worsening ascites occurred less frequently in the early TIPS group (13.5% vs 38.5%, P = 0.008). There was no significant difference in the rate of overt hepatic encephalopathy between the two groups (45.9% vs 36.9%, P = 0.372).

Conclusion: While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB, it is associated with reduced risks of rebleeding and ascites.