Glue Embolization of Gastroesophageal Varices during Transjugular Intrahepatic Portosystemic Shunt (TIPS) Improves Survival Compared to Coil-only Embolization—A Single-Center Retrospective Study

Abstract

To compare the safety and effectiveness of coil versus glue embolization of gastroesophageal varices during transjugular intrahepatic portosystemic shunt (TIPS) creation. In this monocentric retrospective study 104 (males: 67 (64%)) patients receiving TIPS with concomitant embolization of GEV and a minimum follow-up of one year (2008—2017) were included. Primary outcome parameter was overall survival (6 week; 1 year). Six-week overall survival was assessed as a surrogate for treatment failure as proposed by the international Baveno working group. Secondary outcome parameters were development of acute-on-chronic liver failure (ACLF), variceal rebleeding and hepatic encephalopathy (HE). Survival analysis was performed using Kaplan–Meier with log-rank test and adjusted Cox regression analysis. Indications for TIPS were refractory ascites (n\u2009=\u200933) or variceal bleeding (n\u2009=\u200971). Embolization was performed using glue with or without coils (n\u2009=\u200940) (Group G) or coil-only (n\u2009=\u200964) (Group NG). Overall survival was significantly better in group G (p\u2009=\u20090.022; HR\u2009=\u2009-3.333). Six-week survival was significantly lower in group NG (p\u2009=\u20090.014; HR\u2009=\u20096.945). Rates of development of ACLF were significantly higher in group NG after 6 months (NG\u2009=\u200914; G\u2009=\u20096; p\u2009=\u20090.039; HR\u2009=\u20093.243). Rebleeding rates (NG\u2009=\u20096; G\u2009=\u20093; p\u2009=\u20090.74) and development of HE (NG\u2009=\u200922; G\u2009=\u200915; p\u2009=\u20090.75) did not differ significantly between groups. Usage of glue in embolization of GEV may improve overall survival, reduce treatment failure and may be preferable over coil embolization alone.