Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application : A comparison study
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved..
BACKGROUND: It is controversial whether transjugular intrahepatic portosystemic shunt (TIPS) placement can improve long-term survival.
AIM: To assess whether TIPS placement improves survival in patients with hepatic-venous-pressure-gradient (HVPG) ≥ 16 mmHg, based on HVPG-related risk stratification.
METHODS: Consecutive variceal bleeding patients treated with endoscopic therapy + nonselective β-blockers (NSBBs) or covered TIPS placement were retrospectively enrolled between January 2013 and December 2019. HVPG measurements were performed before therapy. The primary outcome was transplant-free survival; secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE).
RESULTS: A total of 184 patients were analyzed (mean age, 55.27 years ± 13.86, 107 males; 102 in the EVL+NSBB group, 82 in the covered TIPS group). Based on the HVPG-guided risk stratification, 70 patients had HVPG < 16 mmHg, and 114 patients had HVPG ≥ 16 mmHg. The median follow-up time of the cohort was 49.5 mo. There was no significant difference in transplant-free survival between the two treatment groups overall (hazard ratio [HR], 0.61; 95% confidence interval [CI]: 0.35-1.05; P = 0.07). In the high-HVPG tier, transplant-free survival was higher in the TIPS group (HR, 0.44; 95%CI: 0.23-0.85; P = 0.004). In the low-HVPG tier, transplant-free survival after the two treatments was similar (HR, 0.86; 95%CI: 0.33-0.23; P = 0.74). Covered TIPS placement decreased the rate of rebleeding independent of the HVPG tier (P < 0.001). The difference in OHE between the two groups was not statistically significant (P = 0.09; P = 0.48).
CONCLUSION: TIPS placement can effectively improve transplant-free survival when the HVPG is greater than 16 mmHg.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
|---|---|
| Enthalten in: |
World journal of gastroenterology - 29(2023), 22 vom: 14. Juni, Seite 3519-3533 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Wang, Xi-Xuan [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Cirrhosis |
|---|
| Anmerkungen: |
Date Completed 03.07.2023 Date Revised 03.07.2023 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.3748/wjg.v29.i22.3519 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM358904854 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM358904854 | ||
| 003 | DE-627 | ||
| 005 | 20231226075732.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.3748/wjg.v29.i22.3519 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1196.xml |
| 035 | |a (DE-627)NLM358904854 | ||
| 035 | |a (NLM)37389231 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Wang, Xi-Xuan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application |b A comparison study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 03.07.2023 | ||
| 500 | |a Date Revised 03.07.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: It is controversial whether transjugular intrahepatic portosystemic shunt (TIPS) placement can improve long-term survival | ||
| 520 | |a AIM: To assess whether TIPS placement improves survival in patients with hepatic-venous-pressure-gradient (HVPG) ≥ 16 mmHg, based on HVPG-related risk stratification | ||
| 520 | |a METHODS: Consecutive variceal bleeding patients treated with endoscopic therapy + nonselective β-blockers (NSBBs) or covered TIPS placement were retrospectively enrolled between January 2013 and December 2019. HVPG measurements were performed before therapy. The primary outcome was transplant-free survival; secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE) | ||
| 520 | |a RESULTS: A total of 184 patients were analyzed (mean age, 55.27 years ± 13.86, 107 males; 102 in the EVL+NSBB group, 82 in the covered TIPS group). Based on the HVPG-guided risk stratification, 70 patients had HVPG < 16 mmHg, and 114 patients had HVPG ≥ 16 mmHg. The median follow-up time of the cohort was 49.5 mo. There was no significant difference in transplant-free survival between the two treatment groups overall (hazard ratio [HR], 0.61; 95% confidence interval [CI]: 0.35-1.05; P = 0.07). In the high-HVPG tier, transplant-free survival was higher in the TIPS group (HR, 0.44; 95%CI: 0.23-0.85; P = 0.004). In the low-HVPG tier, transplant-free survival after the two treatments was similar (HR, 0.86; 95%CI: 0.33-0.23; P = 0.74). Covered TIPS placement decreased the rate of rebleeding independent of the HVPG tier (P < 0.001). The difference in OHE between the two groups was not statistically significant (P = 0.09; P = 0.48) | ||
| 520 | |a CONCLUSION: TIPS placement can effectively improve transplant-free survival when the HVPG is greater than 16 mmHg | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cirrhosis | |
| 650 | 4 | |a Hepatic venous pressure gradient | |
| 650 | 4 | |a Survival | |
| 650 | 4 | |a Transjugular intrahepatic portosystemic shunts | |
| 650 | 4 | |a Variceal rebleeding | |
| 700 | 1 | |a Yin, Xiao-Chun |e verfasserin |4 aut | |
| 700 | 1 | |a Gu, Li-Hong |e verfasserin |4 aut | |
| 700 | 1 | |a Guo, Hui-Wen |e verfasserin |4 aut | |
| 700 | 1 | |a Cheng, Yang |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Xiao, Jiang-Qiang |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Yi |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Wei |e verfasserin |4 aut | |
| 700 | 1 | |a Zou, Xiao-Ping |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Lei |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Ming |e verfasserin |4 aut | |
| 700 | 1 | |a Zhu-Ge, Yu-Zheng |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Feng |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t World journal of gastroenterology |d 1997 |g 29(2023), 22 vom: 14. Juni, Seite 3519-3533 |w (DE-627)NLM117065250 |x 2219-2840 |7 nnns |
| 773 | 1 | 8 | |g volume:29 |g year:2023 |g number:22 |g day:14 |g month:06 |g pages:3519-3533 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.3748/wjg.v29.i22.3519 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 29 |j 2023 |e 22 |b 14 |c 06 |h 3519-3533 | ||