Bleeding ectopic varices in cirrhosis: the role of TIPSS

N Kochar, D Tripathi, N C McAvoy, H Ireland, D N Redhead, P C Hayes

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Introduction: Bleeding from ectopic varices is uncommon but can be difficult to manage. We report here, our experience of use of transjugular intrahepatic portosystemic shunts (TIPSS) in management of uncontrolled bleeding from ectopic varices. Methods: A retrospective study of patients who had TIPSS for bleeding ectopic varices. Patients were selected from a dedicated data base. Results: Over 14 years, of 750 TIPSS insertions, 28 patients had TIPSS for bleeding ectopic varices. (C-P score:8.8+/-1.8). Varices were rectal (12), stomal (8), duodenal (4) and at other sites (4). Concomitant variceal embolisation was performed in 5. Portal pressure gradient fell from 18.2+/-6.4 to 7.2+/-3.5 mmHg. TIPSS achieved haemostasis in 6 of 9 patients who presented with active bleeding. Five patients rebled from ectopic varices. This was related to shunt dysfunction in two and responded to shunt interventions. Three patients rebled despite a functional shunt. Of these, thrombin controlled bleeding in one. Eight patients developed hepatic encephalopathy post-TIPSS. Conclusions: TIPSS is a safe and effective treatment for bleeding ectopic varices. Rebleeding from ectopic varices related to shunt dysfunction responds to shunt intervention. A significant proportion of patients have rebleeding despite a patent shunt where other adjunctive measures like thrombin injection may be tried.
Original languageEnglish
JournalAlimentary Pharmacology and Therapeutics
Publication statusPublished - 2008

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