Interventional Devascularization Plus HVPG-Guided Carvedilol Therapy vs TIPS

Launched by AIR FORCE MILITARY MEDICAL UNIVERSITY, CHINA · Dec 11, 2019

Keywords

ClinConnect Summary

Gastric varices (GV) are present in around 20% of patients with cirrhosis. Bleeding from GV accounts for 10-20% of all variceal bleeding. GV are classified according to their location in the stomach and their relationship with esophageal varices (EV). Accordingly, GV are divided into gastroesophageal varices (GOV) and isolated gastric varices (IGV) . The management of type 1 GOV, which extend from the esophagus along the lesser curvature of the stomach, is similar to the management of EV. Historically, bleeding from type 2 GOV (i.e. GOV extending into the fundus), type 1 IGV (i.e. located i...

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Eligibility criteria

• Inclusion Criteria:
• • Liver cirrhosis diagnosed by clinical examination, imaging or biopsy
• • Patients with a previous history of variceal hemorrhage
• • Gastric variceal confirmed by an endoscopic examination, including IGV1 or IGV2
• • Aged 18 to 75 years
• • Adequate liver and kidney function, including Child-Turcotte-Pugh score \< 12, MELD score \<19, and serum creatinine less than 2 times the upper limit of normal.
• Exclusion Criteria:
• • Active variceal bleeding
• • Esophageal variceal, including GOV1 or GOV2 type, mainly esophageal varices;
• • Refractory ascites
• • Patients with contraindication to treatment of TIPS, including congestive heart failure, NYHA III and IV, pulmonary arterial hypertension(\>50mmHg), polycystic liver, intrahepatic duct dilatation, spontaneous bacterial peritonitis, hepatic encephalopathy
• • Patients with contraindication to treatment of Carvedilol, including asthma, insulin-dependent diabetes, peripheral vascular diseases
• • Child-Turcotte-Pugh score \>=12, or MELD score \>=19
• • Budd-Chiari syndrome
• • The main portal vein thrombosis is greater than 50%
• • Malignancies
• • An uncontrolled infection
• • Previously treated with TIPS, splenectomy pericardia vascular disconnection, or surgical shunts
• • HIV or HIV related illness
• • Allergic to contrast agent
• • Lactating or pregnant
• • Non-compliant patients