PTVE Versus TIPS In Gastric Variceal Bleeding Management

Objective:To compare rebleeding rates、mortality rates and complications in patients treated with percutaneous transhepatic variceal embolization (PTVE) and those treated with transjugular intrahepatic portosystemic shunt (TIPS)Materials and Methods:67 liver cirrhosis patients in Shandong Provincial Hospital Affiliated to Shandong University were admitted because of gastric varices from January 2010 to June 2015. All patients were divided into 2 groups:36 cases in PTVE group,31 cases in TIPS group.Portal venous pressure(PVP) of the two groups before and after treatment were detected and compared. In follow-up period, collectting the data of rebleeding, additional treatment, death time, the cause of death and complications and then analyzing the rebleeding rates, mortality rates and complicatons of 2 groups.Results:The operation success rate of PTVE and TIPS were 97.1% and 93.5%, respectively. Preoperative PVP in PTVE group and TIPS group were (25.07±5.68) mmHg and (26.31±6.18) mmHg, postoperative PVP were (26.04±5.55) mmHg and (18.35±5.74) mmHg. Postoperative PVP was higher than preoperative PVP in PTVE group, without statistically significant (P>0.05). Postoperative PVP was lower than preoperative PVP in TIPS group, and the difference was statistically significant (P<0.05). There was no significant difference in PVP between the two groups before the treatment,while the PVP after treatment had significant difference. All the cases were followed up with an average of (25.34±14.38)months. The total rebleeding rate was 28.1% and the respective rebleeding rates were 33.3% and 22.2%;kThe cumulative rebleeding-free rates at 1,2 and 3 years in PTVE group (79.5%、71.5%、60.4%) were lower than that in TIPS group (88.6%、69.6%、 69.6%), without statistically significant (2=0.080, P=0.777). The mortality rates of 2 groups were 20.0% and 3.7%, respectively. The mortality rate in PTVE gruop was higher then TIPS group, but without statistically significant. The incidence of hepatic encephalopathy after treatment in TIPS group (38.7%) was higher than PTVE group (0.00%), with statistically significant (PK<.05). The postoperation complications of ascites and infection in PTVE group (27.8%、30.6%) were higher than TIPS group (3.2%、6.5%), with statistically significant (P<0.05)Conclusion:1. Both of TIPS and PTVE can reduce the rebleeding rate and mortality effectively.2. In controlling of variceal rebleeding and the probability of survival, there was no significant difference in both PTVE and TIPS group.3. Infection and ascites are more common after PTVE, while hepatic encephalopathy is more common after TIPS.