International Journal of Gastrointestinal Intervention

pISSN 2636-0004 eISSN 2636-0012

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< Previous Next >Gastrointestinal Intervention 2012; 1(1): 3~78

Original Article 2012-12-30

Predictors of early mortality post transjugular intrahepatic portosystemic shunts and the role of hepatic venous pressure gradient

Renumathy Dhanasekaran, Patrick Gonzales, Jonathan West, Ram Subramanian, Samir Parekh, James R. Spivey, Preeti Reshamwala, Louis G. Martin, and Hyun S. Kim

https://doi.org/10.1016/j.gii.2012.08.008

Abstract : BackgroundThis study was conducted to identify factors associated with early mortality (30-day, 60-day) among patients with cirrhosis and portal hypertension who undergo transjugular intrahepatic portosystemic shunts (TIPS).MethodsConsecutive patients who underwent TIPS between January 1993 and December 2008 were included in the study. Clinical, laboratory, and procedural data were collected for all patients by retrospective chart review. Qualitative variables were compared by chi square test and quantitative variables by Student’s t-test. Multinomial logistic regression was used for multivariate analysis.ResultsA total of 643 patients had complete data and were included in the study. The incidence of 30-day mortality in the study group was 17.4% (112/ 643), and the incidence of 60-day mortality was 22.6% (145/643). Univariate analysis was carried out comparing these risk factors in patients stratified by 30-day and 60-day mortality. On univariate analysis, pre-TIPS bilirubin >2.0 mg, pre-TIPS albumin <2.5 gm/dL, pre-TIPS international normalized ratio > 2, pre-TIPS creatinine >2.0, pre-TIPS MELD (Model for End-stage Liver Disease) score >20, pre-TIPS hepatic venous pressure gradient (HVPG) >20 mmHg, higher pre-TIPS alanine transaminase, and higher pre-TIPS aspartate transaminase were found to be predictors of both 30- and 60-day mortality. Multivariate analysis showed pre-TIPS creatinine >2 mg/dL, pre-TIPS MELD levels >20 and HVPG (hepatic venous portal gradient) >20 mmHg to be independent and significant predictors of both 30- and 60-day mortality. For every 1 mg/dL rise of creatinine exceeding 2 mg/dL, the odds of 30-day mortality increased by 80% [odds ratio = 1.8 (1.3?2.4)]. A pre-TIPS HVPG of more than 20 mmHg was found to be correlated with worsened 30-day and 60-day mortality in patients with variceal bleed but not in patients with ascites or hydrothorax.ConclusionStepwise model selection determined that serum creatinine >2.0 mg/dL, MELD >20, and pre-TIPS HVPG >20 mmHg were independent predictors of early mortality. A pre-TIPS HVPG of more than 20 mmHg was found to be correlated with worsened 30-day and 60-day mortality in patients with variceal bleed but not in patients with ascites or hydrothorax.

Cited By: 6

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Original Article 2012-12-30

Influence of transjugular intrahepatic portosystemic shunt in patients awaiting orthotopic liver transplant on post-transplant outcome

Patrick Gonzales, Renumathy Dhanasekaran, Jonathan West, Ram Subramanian, Samir Parekh, James R. Spivey, Preeti Reshamwala, Louis G. Martin, and Hyun S. Kim

https://doi.org/10.1016/j.gii.2012.08.009

Abstract : BackgroundThis study was conducted to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in patients awaiting orthotopic liver transplantation (OLT) and to identify factors affecting post-transplant survival.MethodsConsecutive patients who underwent TIPS followed by OLT between January 1991 and December 2008 were included in the study. The Kaplan–Meier method was used for survival analysis. Survival curves were compared using the log rank test.ResultsA total of 129 patients underwent TIPS followed by OLT and were included in our study. The mean age of the group was 54.67 years (SD, 11.45; range, 16–74 years). The mean duration of follow-up was 2.3 years (range, 1 day–15 years). The mean duration between first TIPS placement and OLT was 1.5 years (range, 0.1–13.4 years). The post-transplant survival rates at 1 month, 1 year, 3 years, 5 years, and 10 years were 98%, 82%, 75%, 69%, and 43%, respectively. The technical success rate of the OLT was 100% in patients who had undergone pre-transplant TIPS. The post-transplant survival was not influenced by pre-TIPS portosystemic gradient (P = 0.295) or the drop in pressure after TIPS (P = 0.423). On multivariate analysis, hepatitis C virus positivity [P = 0.001; hazard ratio = 2.50 (1.47–4.25)] and Model for End-stage Liver Disease score [P = 0.015; hazard ratio = 2.45 (1.19–5.02)] were found to be significant predictors of post-transplant long-term survival. The incidence of post-TIPS complications was 32.6% (42/129). The most common complication was procedure-related bleeding (8.5%) followed by hepatic encephalopathy (7.0%).ConclusionPost-transplant survival in patients who undergo TIPS before OLT is excellent. Higher Model for End-stage Liver Disease scores and hepatitis C positivity result in worse post-transplant survival.

Cited By: 3

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Original Article 2012-12-30

Balloon dilation of benign small bowel strictures using double balloon enteroscopy: 5-year review from a single tertiary referral center

S. Irani, B. Balmadrid, G. Seven, A. Ross, S.I. Gan, M. Gluck, and R. Kozarek

https://doi.org/10.1016/j.gii.2012.08.007

Abstract : BackgroundSmall bowel strictures are an uncommon but difficult problem to evaluate and treat. They can cause significant morbidity, and surgery has historically been the only definitive treatment option. We assessed outcomes of endoscopic dilation of benign small bowel strictures using double balloon enteroscopy (DBE).MethodsRetrospective study of 13 patients from January 2007 to December 2011 who underwent DBE and balloon dilation for benign small bowel strictures at a single tertiary referral center.ResultsA total of 16 DBEs were performed in 13 patients (11 males, median age 60) for benign small bowel strictures using DBE. Final stricture etiology included Crohn’s disease 4, nonsteroidal anti-inflammatory drugs 4, anastomotic stricture 3, radiation enteritis 1, and adhesions 1. Technical success was achieved in 12/13 (92%) and clinical success in 10/13 (77%) patients with a median follow-up of 46 months. Surgery was required in three patients: one technical failure to reach the stricture, one adverse event (perforation), and one recurrence.ConclusionBalloon dilation of small bowel strictures using DBE is a reasonably safe and feasible alternative to surgery in selected cases. Larger prospective series would be required to confirm its benefit.

Cited By: 10

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