Background/Aims
Bleeding ectopic varices due to cirrhosis can be difficult to manage. We report our
experience of uncontrolled bleeding from ectopic varices treated with transjugular
intrahepatic porto-systemic shunt (TIPS).
Methods
We selected the 21 cirrhotics who underwent TIPS for bleeding ectopic varices from
our database: Child-Pugh grade A (2), B (11) and C (8). Site of bleeding was rectal
(11), colonic (2), ileal 1, jejunal 1, duodenal 1, and stomal (5).
Results
TIPS was performed successfully in 19/21 (90%) patients. All except 1 had either a
reduction in portosystemic pressure gradient ≤ 12 mmHg (n=12) or reduction by 25–50% of baseline (n=6). TIPS alone was used in 12/19: 7 of these 12 had no further bleeding; 5 (42%)
rebled within 48 h, and had embolisation, 4 without further bleeding. In 7 of 19, TIPS and embolisation
were performed together: 2 patients (28%) rebled; further embolisation stopped the
bleeding.
Conclusions
Ectopic varices do rebleed despite a reduction of porto-systemic pressure gradient
≤ 12 mmHg or by 25–50% of baseline, following TIPS. Embolisation stopped bleeding in all
but 1 patient. We recommend performing embolisation at the time of the initial TIPS
to control bleeding from ectopic varices.
Keywords
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Article info
Publication history
Published online: September 13, 2004
Accepted:
June 25,
2004
Received in revised form:
May 30,
2004
Received:
February 9,
2004
Identification
Copyright
© 2004 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
