Liver and Bile

Clin Gastroenterol Hepatol. 2025;23(6):965-977.e20

Xia Y, Tie J, Wang G, Zhuge Y, Wu H, Zhu X, Xue H, Xu J, Zhang F, Zhao L, Huang G, Zhang M, Wei B, Li P, Wang Z, Wu W, Chen C, Yang S, Han Y, Tang C, Zhang C

Small transjugular intrahepatic portosystemic shunt plus variceal embolization for gastric varices: A multicenter cohort study

Background and aims: The effect of transjugular intrahepatic portosystemic shunt (TIPS) plus variceal embolization for treating gastric varices (GVs) remains controversial. This nationwide multicenter cohort study aimed to evaluate whether adding variceal embolization to a small diameter (8-mm) TIPS could reduce the rebleeding incidence in patients with different types of GVs.
Methods: This retrospective cohort study involved 629 patients who underwent 8-mm TIPS for gastric varices at 7 medical centers. The primary endpoint was all-cause rebleeding, and the secondary endpoints included overt hepatic encephalopathy (OHE) and all-cause mortality.
Results: A total of 629 patients were included. Among them, 429 (68.2%) had gastroesophageal varices type 1 (GOV1), 145 (23.1%) had gastroesophageal varices type 2 (GOV2), and 55 (8.7%) had isolated gastric varices type 1 (IGV1). In the entire cohort, adjunctive embolization reduced rebleeding (6.2% vs. 13.6%; p = 0.005) and OHE (31.0% vs. 39.4%; p = 0.02) compared with TIPS alone. However, no significant differences were found in mortality (12.0% vs. 9.7%; p = 0.42). In patients with GOV2 and IGV1, TIPS plus variceal embolization reduced both rebleeding (GOV2: 7.8% vs. 25.1%; p = 0.01; IGV1: 5.6% vs. 30.8%; p = 0.03) and OHE (GOV2: 31.8% vs. 51.5%; p = 0.008; IGV1: 11.6% vs. 38.5%; p = 0.04). However, in patients with GOV1, adjunctive embolization did not reduce rebleeding (5.9% vs. 8.7%; p = 0.37) or OHE (33.1% vs. 35.3%; p = 0.60).

Conclusions: Compared with TIPS alone, 8-mm TIPS plus variceal embolization reduced rebleeding and overt hepatic encephalopathy in patients with gastroesophageal varices type 2 (GOV2) and isolated gastric varices type 1 (IGV1). These findings suggest that patients with GOV2 and IGV1, rather than gastroesophageal varices type 1, could benefit from embolization with TIPS.

C. Zhang, Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, China, E-Mail: zhangchunqing_sdu@163.com

and

C. Tang, Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan Province, China, E-Mail: shcqcdmed@163.com

DOI: 10.1016/j.cgh.2024.04.037

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