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Titolo:
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT VERSUS ENDOSCOPIC SCLEROTHERAPY FOR THE PREVENTION OF VARICEAL BLEEDING IN CIRRHOSIS - A RANDOMIZED MULTICENTER TRIAL
Autore:
MERLI M; SALERNO F; RIGGIO O; DEFRANCHIS R; FIACCADORI F; MEDDI P; PRIMIGNANI M; PEDRETTI G; MAGGI A; CAPOCACCIA L; LOVARIA A; UGOLOTTI U; SALVATORI F; BEZZI M; ROSSI P;
Indirizzi:
UNIV ROMA LA SAPIENZA,INST GASTROENTEROL 2,VIALE UNIV 37 I-00185 ROMEITALY UNIV ROMA LA SAPIENZA,INST GASTROENTEROL 2 I-00185 ROME ITALY UNIV ROMA LA SAPIENZA,INST RADIOL SCI 2 I-00185 ROME ITALY UNIV PARMA,INST INFECT DIS I-43100 PARMA ITALY UNIV PARMA,INST RADIOL SCI I-43100 PARMA ITALY UNIV MILAN,INST INTERNAL MED MILAN ITALY OSPED MAGGIORE,IRCCS,DEPT RADIOL MILAN ITALY UNIV MILAN,OSPED MAGGIORE,IRCCS,EMERGENCY SURG MILAN ITALY UNIV ROMA LA SAPIENZA,INST GEN SURG 1 ROME ITALY
Titolo Testata:
Hepatology
fascicolo: 1, volume: 27, anno: 1998,
pagine: 48 - 53
SICI:
0270-9139(1998)27:1<48:TIPSVE>2.0.ZU;2-A
Fonte:
ISI
Lingua:
ENG
Soggetto:
STENT-SHUNT; HEMORRHAGE; ENCEPHALOPATHY; RISK;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
19
Recensione:
Indirizzi per estratti:
Citazione:
M. Merli et al., "TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT VERSUS ENDOSCOPIC SCLEROTHERAPY FOR THE PREVENTION OF VARICEAL BLEEDING IN CIRRHOSIS - A RANDOMIZED MULTICENTER TRIAL", Hepatology, 27(1), 1998, pp. 48-53

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS), a new techniquefor the treatment of portal hypertension, has been successful in preliminary studies to treat acute variceal hemorrhage and to prevent variceal rebleeding. The purpose of this multicenter, randomized controlled trial is to compare the efficacy of TIPS with that of endoscopic sclerotherapy in the prevention of variceal rebleeding in cirrhosis. Eighty-one cirrhotic patients, with endoscopically proven variceal bleeding, were randomized to either TIPS (38 patients) or endoscopic sclerotherapy (43 patients). Randomization was stratified according to the following: if bleeding occurred < 1 week (stratum I); if bleeding: occurred 1 to 6 weeks (stratum II); and if bleeding occurred 6 weeks to 6 months (stratum III) before enrollment. Follow-up included clinical, biochemical, Doppler Ultrasound, and endoscopic examinations every 6 months. During a mean follow-up of 17.7 months, 51% of the patients treated with sclerotherapy and 24% of those treated with TIPS rebled (P = .011). Mortality was 19% in sclerotherapy patients and 24% in TIPS patients (P = .50). Hepatic encephalopathy (HE) developed in 26% and 55%, respectively (P = .006). A separate analysis of the three strata showedthat TIPS was significantly more effective than sclerotherapy (P = .026) in preventing rebleeding only in stratum I patients. TIPS is significantly better than sclerotherapy in preventing rebleeding only when it is performed shortly after a variceal bleed; however, TIPS does notimprove survival and is associated with a significantly higher incidence of HE. The overall performance of TIPS does not seem to justify the adoption of this technique as a first-choice treatment to prevent rebleeding from esophageal varices in cirrhotic patients.

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Documento generato il 30/11/20 alle ore 10:10:46