Abstract：
OBJECTIVE: 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 = .005) and OHE (31.0% vs 39.4%; P = .02) compared with TIPS alone. However, no significant differences were found in mortality (12.0% vs 9.7%; P = .42). In patients with GOV2 and IGV1, TIPS plus variceal embolization reduced both rebleeding (GOV2: 7.8% vs 25.1%; P = .01; IGV1: 5.6% vs 30.8%; P = .03) and OHE (GOV2: 31.8% vs 51.5%; P = .008; IGV1: 11.6% vs 38.5%; P = .04). However, in patients with GOV1, adjunctive embolization did not reduce rebleeding (5.9% vs 8.7%; P = .37) or OHE (33.1% vs 35.3%; P = .60).
CONCLUSIONS: Compared with TIPS alone, 8-mm TIPS plus variceal embolization reduced rebleeding and OHE in patients with GOV2 and IGV1. These findings suggest that patients with GOV2 and IGV1, rather than GOV1, could benefit from embolization with TIPS.
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 = .005) and OHE (31.0% vs 39.4%; P = .02) compared with TIPS alone. However, no significant differences were found in mortality (12.0% vs 9.7%; P = .42). In patients with GOV2 and IGV1, TIPS plus variceal embolization reduced both rebleeding (GOV2: 7.8% vs 25.1%; P = .01; IGV1: 5.6% vs 30.8%; P = .03) and OHE (GOV2: 31.8% vs 51.5%; P = .008; IGV1: 11.6% vs 38.5%; P = .04). However, in patients with GOV1, adjunctive embolization did not reduce rebleeding (5.9% vs 8.7%; P = .37) or OHE (33.1% vs 35.3%; P = .60).
CONCLUSIONS: Compared with TIPS alone, 8-mm TIPS plus variceal embolization reduced rebleeding and OHE in patients with GOV2 and IGV1. These findings suggest that patients with GOV2 and IGV1, rather than GOV1, could benefit from embolization with TIPS.
摘要：
目的：经颈静脉肝内门体分流术（TIPS）加静脉曲张栓塞治疗胃底静脉曲张（GVs）的疗效仍存在争议。这项全国性的多中心队列研究旨在评估在小直径（8-mm）TIPS中添加静脉曲张栓塞是否可以降低不同类型GV患者的再出血发生率。
方法：这项回顾性队列研究纳入了7个医疗中心的629例因胃底静脉曲张而接受8mmTIPS治疗的患者。主要终点是全因再出血，次要终点包括明显肝性脑病(OHE)和全因死亡率.
结果：共纳入629例患者。其中,429（68.2％）患有1型胃食管静脉曲张（GOV1），145（23.1％）患有2型胃食管静脉曲张（GOV2），55例（8.7％）患有1型胃静脉曲张（IGV1）。在整个队列中，辅助栓塞可减少再出血(6.2%对13.6%,P=0.005）和OHE（31.0%对39.4%，P=0.02）与单独的TIPS相比。然而,死亡率无显著差异(12.0%对9.7%，P=0.42）。在GOV2和IGV1患者中，TIPS+E减少了两者的再出血（GOV2：7.8％对25.1％，P=0.01；IGV1：5.6%对30.8%，P=0.03）和OHE（GOV2：31.8%对51.5%，P=0.008；IGV1：11.6%对38.5%，P=0.04)。然而,在GOV1患者中，辅助栓塞并不能减少再出血（5.9%对8.7%，P=0.37)或OHE(33.1%对35.3%，P=0.60）。
结论：与单独的TIPS相比，8毫米TIPS加静脉曲张栓塞可减少GOV2和IGV1患者的再出血和OHE。这些发现表明，GOV2和IGV1而不是GOV1的患者可以从TIPS栓塞中受益。
方法：这项回顾性队列研究纳入了7个医疗中心的629例因胃底静脉曲张而接受8mmTIPS治疗的患者。主要终点是全因再出血，次要终点包括明显肝性脑病(OHE)和全因死亡率.
结果：共纳入629例患者。其中,429（68.2％）患有1型胃食管静脉曲张（GOV1），145（23.1％）患有2型胃食管静脉曲张（GOV2），55例（8.7％）患有1型胃静脉曲张（IGV1）。在整个队列中，辅助栓塞可减少再出血(6.2%对13.6%,P=0.005）和OHE（31.0%对39.4%，P=0.02）与单独的TIPS相比。然而,死亡率无显著差异(12.0%对9.7%，P=0.42）。在GOV2和IGV1患者中，TIPS+E减少了两者的再出血（GOV2：7.8％对25.1％，P=0.01；IGV1：5.6%对30.8%，P=0.03）和OHE（GOV2：31.8%对51.5%，P=0.008；IGV1：11.6%对38.5%，P=0.04)。然而,在GOV1患者中，辅助栓塞并不能减少再出血（5.9%对8.7%，P=0.37)或OHE(33.1%对35.3%，P=0.60）。
结论：与单独的TIPS相比，8毫米TIPS加静脉曲张栓塞可减少GOV2和IGV1患者的再出血和OHE。这些发现表明，GOV2和IGV1而不是GOV1的患者可以从TIPS栓塞中受益。
