Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding

被引：24

作者：

Rudler, Marika ^{[1
,2
,3
]}

Hernandez-Gea, Virginia ^{[4
]}

Procopet, Bogdan Dumitru ^{[5
,6
]}

Giraldez, Alvaro ^{[7
]}

Amitrano, Lucio ^{[8
]}

Villanueva, Candid ^{[9
,10
]}

Ibanez, Luis ^{[11
,12
]}

Silva-Junior, Gilberto ^{[4
]}

Genesca, Joan ^{[13
]}

Bureau, Christophe ^{[14
]}

Trebicka, Jonel ^{[15
]}

Banares, Rafael ^{[16
]}

Krag, Aleksander ^{[17
]}

Llop, Elba ^{[18
,19
]}

Laleman, Wim ^{[20
]}

Palazon, Jose Maria ^{[21
]}

Castellote, Jose ^{[22
]}

Rodrigues, Susana ^{[23
]}

Gluud, Lise Lotte ^{[24
]}

Noronha Ferreira, Carlos ^{[25
]}

Canete, Nouria ^{[26
]}

Rodriguez, Manuel ^{[27
]}

Ferlitsch, Arnulf ^{[28
]}

Mundi, Jose Luis ^{[29
]}

Gronbaek, Henning ^{[30
]}

Hernandez-Guerra, Manuel ^{[31
]}

Sassatelli, Romano ^{[32
]}

Dell'era, Alessandra ^{[33
,34
]}

Senzolo, Marco ^{[35
]}

Abraldes, Juan G. ^{[36
]}

Romero-Gomez, Manuel ^{[37
]}

Zipprich, Alexander ^{[38
]}

Casas, Meritxell ^{[39
]}

Masnou, Helena ^{[40
]}

Larrue, Helene ^{[41
]}

Primignani, Massimo ^{[42
]}

Nevens, Frederik ^{[43
]}

Calleja, Jose Luis ^{[44
,45
]}

Schwarzer, Remy ^{[28
]}

Jansen, Christian ^{[46
]}

Robic, Marie-Angele ^{[41
]}

Conejo, Irene ^{[47
,48
]}

Martinez Gonzalez, Javier ^{[49
]}

Catalina, Maria Vega ^{[50
]}

Albillos, Agustin ^{[51
,52
]}

Alvarado, Edilmar ^{[53
]}

Guardascione, Maria Anna ^{[54
]}

Mallet, Maxime ^{[1
]}

Tripon, Simona ^{[1
]}

Casanovas, Georgina ^{[55
]}

机构：

[1] Sorbonne Univ, Hop Pitie Salpetriere, Groupement Hosp APHP, Hepatol & gastroenterol,Unite Soins Intensifs H, Paris, France

[2] Sorbonne Univ, INSERM, Ctr Rech Saint Antoine CRSA, Inst Cardiometabolism & Nutr ICAN, Paris, France

[3] Sorbonne Univ, APHP, Brain Liver Pitie Salpetriere Study Grp BLIPS, Paris, France

[4] Hosp Clin Barcelona, IDIBAPS & CIBERehd, Liver Unit, Hepat Hemodynam Lab, Barcelona, Spain

[5] Octavian Fodor, Gastroenterol Reg Inst Gastroenterol & Hepatol, Cluj Napoca, Romania

[6] Univ Med & Pharm Iuliu Hatieganu, Gastroenterol, Cluj Napoca, Romania

[7] Hosp Univ Virgen Rocio, Hepatol, Seville, Spain

[8] A Cardarelli Hosp, Gastroenterol, Naples, Italy

[9] Barcelona Autonomous Univ, Hosp Santa Creu Sant Pau, Dept Gastroenterol, Barcelona, Spain

[10] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain

[11] Univ Complutense Madrid, Inst Invest Sanitaria Gregorio Maranon IiSGM, Hosp Univ Gregorio Maranon, Gastroenterol & Hepatol, Madrid, Spain

[12] Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain

[13] Hosp Univ Vall Hebron, Internal Med Liver Unit, Barcelona, Spain

[14] Univ Hosp, Hepato Gastroenterol, Toulouse, France

[15] Goethe Univ Frankfurt Main, Dept Internal Med 1, Translat Hepatol, Frankfurt, Germany

[16] Hosp Gen Univ Gregorio Maranon, IRYCIS, Gastroenterol, Madrid, Spain

[17] Univ Southern Denmark, Odense Univ Hosp, Dept Gastroenterol, Odense, Denmark

[18] Univ Barcelona, IDIBAPS, Hosp Clin, Hepat Hemodynam Lab Liver Unit, Barcelona, Spain

[19] CIBERehd, Barcelona, Spain

[20] Katholieke Univ Leuven, Univ Leuven, Div Liver & Biliopancreat Disorders, Leuven, Belgium

[21] Hosp Gen Univ Alicante, Alicante, Spain

[22] Hosp Univ Bellvitge, Digest Dis, Lhospitalet De Llobregat, Spain

[23] Ctr Hosp Sao Joao, Fac Med, Dept Gastroenterol, Porto, Portugal

[24] Univ Copenhagen, Fac Hlth & Med Sci, Hvidovre Univ Hosp, Gastrounit,Med Div, Copenhagen, Denmark

[25] Hosp Santa Maria, Gastroenterol, Lisbon, Portugal

[26] Univ Autonoma Barcelona, Hosp Mar, Dept Gastroenterol, Liver Sect, Barcelona, Spain

[27] Hosp Cent Asturias, Dept Gastroenterol, Oviedo, Spain

[28] Med Univ Vienna, Div Gastroenterol & Hepatol, Internal Med 3, Vienna, Austria

[29] Univ Hosp San Cecilio, Dept Gastroenterol, Granada, Spain

[30] Aarhus Univ Hosp, Dept Hepatol & Gastroenterol, Aarhus, Denmark

[31] Univ Hosp Canary Islands, Liver Unit, Santa Cruz De Tenerife, Spain

[32] IRCCS Santa Maria Nuova, Endoscopy Unit, Reggio Emilia, Italy

[33] Univ Milan, Dipartimento Sci Biomed & Clin, Milan, Italy

[34] UOC Gastroenterol Endoscopia, Aziende Socio Sanitarie Territoriale Fatebenefrat, Milan, Italy

[35] Univ Padua, Dept Surg & Gastroenterol Sci, Multivisceral Transplant Unit, Padua, Italy

[36] Univ Alberta, Cirrhosis Care Clin, Edmonton, AB, Canada

[37] Hosp Univ Valme, Unit Clin Management Digest Dis & CIBERehd, Seville, Spain

[38] Martin Luther Univ Halle Wittenberg, Dept Internal Med 1, Halle, Germany

[39] Corporac Sanitaria Parc Tauli, Dept Gastroenterol, Liver Unit, Sabadell, Spain

[40] Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Barcelona, Spain

[41] CHU Purpan, Serv DHepatogastro Enterol, Toulouse, France

[42] Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policli, Div Gastroenterol & Hepatol, Milan, Italy

[43] UZ Leuven, Hepatol, Leuven, Belgium

[44] Hosp Univ Puerta Hierro Majadahonda, Gastroenterol & Hepatol, IDIPHISA, Majadahonda, Spain

[45] Ctr Invest Biomed Red Enfermedades Hepat & Digest, CIBERehd, Inst Salud Carlos III, Madrid, Spain

[46] Univ Bonn, Internal Med, Bonn, Germany

[47] Univ Autonoma Barcelona, Vall Hebron Inst Res VHIR, Hosp Univ Vall Hebron, Liver Unit, Barcelona, Spain

[48] CIBERehd, Barcelona, Spain

[49] Univ Alcala, IRYCIS, Hosp Univ Ramon & Cajal, Dept Gastroenterol, Madrid, Spain

[50] Hosp Gen Univ Gregorio Maranon, CIBERehd, Serv Med Aparato Digestivo Gregorio Maranon, Madrid, Spain

来源：

GUT | 2023年 / 72卷 / 04期

关键词：

cirrhosis; hepatic encephalopathy; oesophageal varices; PORTAL-HYPERTENSION; AMERICAN ASSOCIATION; CONSENSUS WORKSHOP; METAANALYSIS; PLACEMENT; DIAGNOSIS; MELD;

D O I：

10.1136/gutjnl-2022-326975

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background A pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that <15% of patients eligible for pTIPS ultimately undergo transjugular intrahepatic portosystemic shunt (TIPS) due to concerns about hepatic encephalopathy (HE). The outcome of patients undergoing pTIPS with HE is unknown. We aimed to (1) assess the prevalence of HE in patients with AVB; (2) evaluate the outcome of patients presenting HE at admission after pTIPS; and (3) determine if HE at admission is a risk factor for death and post-TIPS HE. Patients and methods This is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation. Results 671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p<0.001). In high-risk patients with HE at admission, pTIPS was associated with a lower 1-year mortality than endoscopic+drug (HR 0.374, 95% CI 0.166 to 0.845, p=0.0181). The incidence of HE was not different between patients treated with pTIPS and endoscopic+drug (38.2% vs 38.7%, p=0.9721), even in patients with HE at admission (56.4% vs 58.7%, p=0.4594). Age >56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients. Conclusion pTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.

引用

页码：749 / 758

页数：10

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