The clinical efficacy of transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization for portal hypertension complicated by upper gastrointestinal bleeding

Objective To evaluate transjugular intrahepatic portosystemic shunt(TIPS) combined with gastric coronary vein embolization(GCVE) in treating portal hypertension complicated by upper gastrointestinal bleeding.Methods A total of 54 patients with upper gastrointestinal hemorrhage due to cirrhotic portal hypertension were enrolled in this study.TIPS together with GCVE was carried out in all patients.Preoperative liver function Child-Pugh grade A,B and C had 16 cases,28 cases and 10 cases respectively.After the treatment all the patients were followed up for 9-42 months.The patients were kept under close observation for the clinical efficacy,complications,hepatic as well as renal function changes.Results TIPS together with GCVE was successfully accomplished in all the 54 patients.After the treatment,the bleeding stopped and the portosystemic pressure gradient was significantly reduced.ALT,AST,TBIL and DBIL levels determined at 3 days,one week and one month after the treatment showed an elevation to some degree,which gradually decreased to preoperative levels in 6 months.The serum urea nitrogen and creatinine levels showed a dramatic reduction one week after the treatment(P 0.05),and this decreasing trend lasted for half a year.The incidence of re-bleeding at one,6,12,24 and 36 months after the treatment was 0%,3.7%,9.3%,14.8% and 20.4% respectively.The cumulated stent stenosis rate was 27.8%.The occurrence of hepatic coma was 24.1%.During the follow-up period 7 patients died from primary hepatocellular carcinoma(n = 2),massive gastrointestinal bleeding(n = 4) or multiple organs functional failure(n = 1).Conclusion For upper gastrointestinal hemorrhage due to cirrhotic portal hypertension,transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization is a safe and effective treatment.This method can be repeatedly employed and it carries reliable clinical efficacy with a lower recurrence rate.