TIPS in patients treated with balloon tamponade for variceal hemorrhage without response to high doses of vasoactive drugs: a real‐world multicenter retrospective study

AIM This study evaluated the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) and non-TIPS (endoscopy +/- nonselective beta-blockers) therapy in cirrhotic patients with active variceal hemorrhage without response to high doses of vasoactive drugs and who needed balloon tamponade for hemostasis. METHODS We retrospectively contained 136 consecutive cirrhotic patients admitted to five university hospitals in China between 2011 and 2018, who showed no response to high doses of vasoactive drugs and required balloon tamponade, thereafter received TIPS (66 patients) or non-TIPS (70 patients) therapy. We compared the outcomes and complications between the two groups. RESULTS None in the TIPS group and six patients in the non-TIPS group failed to control variceal hemorrhage within 5 days (P=0.028). The TIPS group had a higher 1-year probability of free of variceal rebleeding compared with non-TIPS group (95.5% versus 60%, P<0.001). One patient in the TIPS group and nine patients with non-TIPS experienced rebleeding during 5 days and 6 weeks interval (P=0.009). The cumulative incidence of 1-year survival was higher in the TIPS group than in the non-TIPS group (93.9% versus 78.6%, P=0.01). TIPS group had a higher 1-year probability of hepatic encephalopathy than non-TIPS (18.2% versus 5%, P=0.026). CONCLUSION For cirrhotic patients with active variceal bleeding who are unresponsive to high doses of vasoactive agents, and need balloon tamponade for hemostasis, TIPS may be a more appropriate treatment choice. This article is protected by copyright. All rights reserved.