Xia Yifu, Tie Jun, Wang Guangchuan, Zhuge Yuzheng, Wu Hao, Zhu Xiaoli, Xue Hui, Xu Jiao, Zhang Feng, Zhao Lianhui, Huang Guangjun, Zhang Mingyan, Wei Bo, Li Peijie, Wang Ze, Wu Wei, Chen Chao, Yang Shifeng, Han Yicheng, Tang Chengwei, Zhang Chunqing
Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China.
Clin Gastroenterol Hepatol. 2025 May;23(6):965-977.e20. doi: 10.1016/j.cgh.2024.04.037. Epub 2024 May 16.
BACKGROUND & 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.
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.
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).
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.
经颈静脉肝内门体分流术（TIPS）联合曲张静脉栓塞术治疗胃静脉曲张（GVs）的效果仍存在争议。这项全国性多中心队列研究旨在评估在小直径（8毫米）TIPS基础上加用曲张静脉栓塞术是否能降低不同类型GVs患者的再出血发生率。
这项回顾性队列研究纳入了7家医疗中心629例行8毫米TIPS治疗胃静脉曲张的患者。主要终点为全因再出血，次要终点包括显性肝性脑病（OHE）和全因死亡率。
共纳入629例患者。其中，429例（68.2%）为1型胃食管静脉曲张（GOV1），145例（23.1%）为2型胃食管静脉曲张（GOV2），55例（8.7%）为1型孤立性胃静脉曲张（IGV1）。在整个队列中，与单纯TIPS相比，辅助栓塞术降低了再出血发生率（6.2%对13.6%；P = 0.005）和OHE发生率（31.0%对39.4%；P = 0.02）。然而，在死亡率方面未发现显著差异（12.0%对9.7%；P = 0.42）。在GOV2和IGV1患者中，TIPS联合曲张静脉栓塞术降低了再出血发生率（GOV2：7.8%对25.1%；P = 0.01；IGV1：5.6%对30.8%；P = 0.03）和OHE发生率（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，辅助栓塞术并未降低再出血发生率（5.9%对8.7%；P = 0.37）或OHE发生率（33.1%对35.3%；P = 0.60）。
与单纯TIPS相比，8毫米TIPS联合曲张静脉栓塞术降低了GOV2和IGV1患者的再出血发生率和OHE发生率。这些发现表明，GOV2和IGV1患者而非GOV1患者可能从TIPS联合栓塞术中获益。
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