Shalaby Sarah, Nicoară-Farcău Oana, Perez-Campuzano Valeria, Olivas Pol, Torres Sonia, García-Pagán Juan Carlos, Hernández-Gea Virginia
Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain.
Fundació de Recerca Clínic Barcelona (FRCB-IDIABPS), CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RareLiver), 08036 Barcelona, Spain.
J Clin Med. 2024 Sep 24;13(19):5681. doi: 10.3390/jcm13195681.
Acute variceal bleeding in cirrhosis represents a critical clinical event that significantly impacts patient prognosis, with mortality rates increasing further after a second episode. This underscores the need for immediate intervention and optimal prophylaxis. The creation of a transjugular intrahepatic portosystemic shunt (TIPS) has been proven to be highly effective for managing esophageal variceal bleeding. However, the use of TIPS for managing cardiofundal gastric varices and ectopic varices remains debated due to their unique vascular anatomy and the limited data available. These varices, although less prevalent than esophageal varices, are complex and heterogeneous vascular shunts between the splanchnic venous system and the systemic veins. Indeed, while endoscopic therapy with tissue adhesives is widely endorsed for achieving hemostasis in active hemorrhage, there is no consensus regarding the optimal approach for secondary prophylaxis. Recent research emphasizes the efficacy of endovascular techniques over endoscopic treatments, such as TIPS and endovascular variceal embolization techniques. This review examines the use of TIPS in managing acute variceal bleeding in patients with cirrhosis, focusing specifically on cardiofundal gastric varices and ectopic varices, discussing optimal patient care based on the latest evidence, aiming to improve outcomes for this challenging subset of patients.
肝硬化患者的急性静脉曲张出血是一个关键的临床事件，会显著影响患者预后，第二次发作后的死亡率会进一步上升。这凸显了立即干预和最佳预防措施的必要性。经颈静脉肝内门体分流术（TIPS）已被证明在治疗食管静脉曲张出血方面非常有效。然而，由于贲门胃底静脉曲张和异位静脉曲张独特的血管解剖结构以及可用数据有限，TIPS在治疗这些静脉曲张方面仍存在争议。这些静脉曲张虽然不如食管静脉曲张常见，但却是内脏静脉系统和体静脉之间复杂且异质性的血管分流。事实上，虽然组织粘合剂内镜治疗被广泛认可用于在活动性出血时实现止血，但对于二级预防的最佳方法尚无共识。最近的研究强调了血管内技术相对于内镜治疗（如TIPS和血管内静脉曲张栓塞技术）的疗效。本综述探讨了TIPS在治疗肝硬化患者急性静脉曲张出血中的应用，特别关注贲门胃底静脉曲张和异位静脉曲张，基于最新证据讨论最佳的患者护理，旨在改善这一具有挑战性的患者亚组的治疗结果。
