Clinical outcome comparison between transjugular intrahepatic portosystemic shunt and endoscopic treatment in patients with cavernous transformation of the portal vein presenting with variceal bleeding: A retrospective study

Abstract

Abstract Background: Cavernous transformation of the portal vein (CTPV) is often associated with portal hypertension and varicose bleeding. Endoscopic treatments (ETs) and transjugular intrahepatic portosystemic shunts (TIPS) can be able to prevent rebleeding in patients with CTPV. This study aimed to compare the clinical outcomes of TIPS and ET in patients with CTPV presenting with variceal bleeding. Methods: We reviewed the data of patients with portal cavernous transformation presenting with variceal bleeding in Nanjing Drum Tower Hospital from February 2014 to January 2021, which included 38 patients who underwent endoscopic treatment and 25 patients who underwent TIPS therapy. Results: During the follow-up period, the upper gastrointestinal rebleeding rate and survival rate have no significant difference between the ET group and TIPS group (P ＞0.05). The median hospitalization cost in the TIPS group ( 93258.00 Chinese Yuan) was significantly higher than that in the ET group (47109.00 Chinese Yuan) (P = 0.001), and the length of hospital stay in the TIPS group ( 14.52 ± 12.00 days) was much shorter than that in the ET group ( 23.05 ± 12.87 days) (P = 0.003). The incidence of OHE in the TIPS group was higher than that in the ET group (P = 0.013). Conclusions: For patients with CTPV presenting with variceal bleeding, TIPS was not superior to ET regarding preventing rebleeding and long-term survival. ET, rather than TIPS, may be a better choice for patients with CTPV presenting with variceal bleeding regarding medical expenses and postoperative complications.