OBJECTIVETo assess the safety and clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with various stents for treating patients with cirrhosis and esophageal gastric varices bleeding.

METHODSOne hundred and five patients were stratified according to stent type: bare stent group, covered stent-grafts group, combined stents group. Rates of success, shunt insufficiency, rebleeding, patient survival, and major complications were observed. The shunt insufficiency rate, rebleeding rate, and survival rate were calculated by the life tables method, the Kaplan-Meier analytical curve, and the log-rank test; a p-value less than 0.05 was considered statistically significant.

RESULTSThe overall success rate of all TIPS for treating the esophageal gastric varices bleeding was 100%. The overall shunt insufficiency rates at 6-, 12-and 24-months post-TIPS were 8%, 9% and 16%, rebleeding rates were 2%, 6% and 17%, and survival rates were 100%, 97% and 94%. The shunt insufficiency rate was 26% in the bare stent group, 14% in the covered stent-grafis group, and 5% in the combined stents group (x2=1.00, P=0.61). The rebleeding rate was 33% in the bare stent group, 7% in the covered stent-grafts group, and 3%in the combined stents group (x2=1.69, P=0.43). The survival rate was 92% in the bare stent group, 93% in the covered stent-grafts group, and 100% in the combined stents group (x2=1.91, P=0.39). The shunt insufficiency rates were higher in patients with splenectomy than in those without splenectomy (30% vs.14%; x2=4.15, P=0.04). The intraperitoneal hemorrhage rates in the covered stent-grafis group and the combined stents group were significantly lower than that in the bare stent group (0% vs 0% vs 13%; x2=8.88, P=0.01).

CONCLUSIONSTIPS with an 8 mm stent effectively treated and prevented esophageal gastric varices bleeding in patients with cirrhosis. Intraperitoneal hemorrhaging caused by TIPS was significantly decreased in the covered stent-grafts group and combined stents group,which represented an improvement in safety of this treatment. However, the influence of covered stent-grafis and combined stents towards the clinical efficacy of TIPS needs further study.

Esophageal Diseases ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Humans ; Kaplan-Meier Estimate ; Liver Cirrhosis ; Portasystemic Shunt, Transjugular Intrahepatic ; Stents ; Survival Rate

Objective:To study the clinical value of SpyGlass direct visualization system-guided radiofrequency ablation (RFA) combined with biliary stent implantation in the treatment of malignant biliary stricture.Methods:Clinical data of 29 patients with advanced malignant biliary stricture without surgical resectability who received palliative endoscopic treatment in Drum Tower Hospital of Nanjing University Medical School and Wuxi No.2 People’s Hospital were retrospectively analyzed, including 20 males and 9 females, aged (70.3±11.5) years. Patients were divided into two groups: the SpyGlass-guided biliary RFA combined with biliary stent implantation treatment group (combined group, n=14) and the simple biliary stent treatment group (simple stent group, n=15). The age, gender, body mass index (BMI), the total bilirubin, jaundice remission, postoperative complications, stent patency time and survival period were compared between the two groups. Results:Among 29 cases, 20 were cholangiocarcinoma (69.0%), 4 were hepatocellular carcinoma (13.8%), 3 were carcinoma of gallbladder (10.3%), and 2 were ampullary carcinoma (6.9%). There were no statistically significant difference in age, male proportion, primary tumor proportion, BMI and total bilirubin between the groups (all P>0.05). The postoperative total bilirubin of the combined group was 41.5(29.8, 52.5)μmol/L, and that of the stent group was 55.4(31.5, 107.1)μmol/L ( Z=1.18, P=0.247). There were 11 cases of jaundice remission in the combined group and 10 in the stent group ( χ2=0.51, P=0.474). The stent patency time in the combined group was 90 (77, 250) days, and that in the stent group was 100 (60, 190) days ( Z=0.28, P=0.793). There was no significant difference in cumulative survival rates and incidence of postoperative complications between the two groups ( P>0.05). Conclusion:SpyGlass-guided biliary RFA combined with biliary stent implantation neither improves the treatment efficacy nor prolongs stent patency time in patients with malignant biliary strictures.