Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis

Cirrhosis; Portal hypertension; Acute variceal bleeding

Detalles Bibliográficos
Autores: Rudler, Marika, Hernandez-Gea, Virginia, Larrue, Hélène, Bouzbib, Charlotte, Procopet, Bogdan, Baiges, Anna, Genesca, Joan, Ventura-Cots, Meritxell, Villagrasa, Ares
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Consejo Superior de Investigaciones Científicas (CSIC)
Repositorio:Scientia. Dipòsit d'Informació Digital del Departament de Salut
OAI Identifier:oai:scientiasalut.gencat.cat:11351/14165
Acceso en línea:http://hdl.handle.net/11351/14165
Access Level:acceso abierto
Palabra clave:Hepatitis - Tractament
Varices esofàgiques
Hemorràgia
Hepatitis - Cirurgia
DISEASES::Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, Alcoholic
DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Esophageal Diseases::Esophageal and Gastric Varices
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Anastomosis, Surgical::Portasystemic Shunt, Surgical::Portasystemic Shunt, Transjugular Intrahepatic
DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis alcohólica
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades del esófago::varices esofágicas y gástricas
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::anastomosis quirúrgica::derivación portosistémica quirúrgica::derivación portosistémica intrahepática transyugular
ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::hemorragia
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oai_identifier_str oai:scientiasalut.gencat.cat:11351/14165
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
title Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
spellingShingle Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
Rudler, Marika
Hepatitis - Tractament
Varices esofàgiques
Hemorràgia
Hepatitis - Cirurgia
DISEASES::Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, Alcoholic
DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Esophageal Diseases::Esophageal and Gastric Varices
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Anastomosis, Surgical::Portasystemic Shunt, Surgical::Portasystemic Shunt, Transjugular Intrahepatic
DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis alcohólica
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades del esófago::varices esofágicas y gástricas
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::anastomosis quirúrgica::derivación portosistémica quirúrgica::derivación portosistémica intrahepática transyugular
ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::hemorragia
title_short Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
title_full Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
title_fullStr Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
title_full_unstemmed Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
title_sort Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitis
dc.creator.none.fl_str_mv Rudler, Marika
Hernandez-Gea, Virginia
Larrue, Hélène
Bouzbib, Charlotte
Procopet, Bogdan
Baiges, Anna
Genesca, Joan
Ventura-Cots, Meritxell
Villagrasa, Ares
author Rudler, Marika
author_facet Rudler, Marika
Hernandez-Gea, Virginia
Larrue, Hélène
Bouzbib, Charlotte
Procopet, Bogdan
Baiges, Anna
Genesca, Joan
Ventura-Cots, Meritxell
Villagrasa, Ares
author_role author
author2 Hernandez-Gea, Virginia
Larrue, Hélène
Bouzbib, Charlotte
Procopet, Bogdan
Baiges, Anna
Genesca, Joan
Ventura-Cots, Meritxell
Villagrasa, Ares
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Institut Català de la Salut
[Rudler M] AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, La Pitié-Salpêtrière Hospital, Paris, France. INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. Brain-Liver Pitié-Salpêtrière Study group (BLIPS), Paris, France. [Hernandez Gea V, Baiges A] Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. [Larrue H] Service d’Hépatologie Hôpital Rangueil CHU Toulouse et Université de Toulouse, Toulouse, France. [Bouzbib C] AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, La Pitié-Salpêtrière Hospital, Paris, France. INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. [Procopet B] Department of Gastroenterology, Hospital de Sant Pau and CIBERehd, Barcelona, Spain. [Genesca J, Ventura-Cots M, Villagrasa A] Servei d’Hepatologia, Àrea de Malalties Digestives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Autonomous University of Barcelona, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
dc.subject.none.fl_str_mv Hepatitis - Tractament
Varices esofàgiques
Hemorràgia
Hepatitis - Cirurgia
DISEASES::Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, Alcoholic
DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Esophageal Diseases::Esophageal and Gastric Varices
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Anastomosis, Surgical::Portasystemic Shunt, Surgical::Portasystemic Shunt, Transjugular Intrahepatic
DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis alcohólica
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades del esófago::varices esofágicas y gástricas
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::anastomosis quirúrgica::derivación portosistémica quirúrgica::derivación portosistémica intrahepática transyugular
ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::hemorragia
topic Hepatitis - Tractament
Varices esofàgiques
Hemorràgia
Hepatitis - Cirurgia
DISEASES::Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, Alcoholic
DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Esophageal Diseases::Esophageal and Gastric Varices
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Anastomosis, Surgical::Portasystemic Shunt, Surgical::Portasystemic Shunt, Transjugular Intrahepatic
DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis alcohólica
ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades del esófago::varices esofágicas y gástricas
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::anastomosis quirúrgica::derivación portosistémica quirúrgica::derivación portosistémica intrahepática transyugular
ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::hemorragia
description Cirrhosis; Portal hypertension; Acute variceal bleeding
publishDate 2025
dc.date.none.fl_str_mv 2025
2025
2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11351/14165
url http://hdl.handle.net/11351/14165
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv JHEP Reports;7(12)
https://doi.org/10.1016/j.jhepr.2025.101611
dc.rights.none.fl_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv Scientia
reponame:Scientia. Dipòsit d'Informació Digital del Departament de Salut
instname:Consejo Superior de Investigaciones Científicas (CSIC)
instname_str Consejo Superior de Investigaciones Científicas (CSIC)
reponame_str Scientia. Dipòsit d'Informació Digital del Departament de Salut
collection Scientia. Dipòsit d'Informació Digital del Departament de Salut
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling Pre-emptive TIPS should be considered in high-risk patients with both acute variceal bleeding and severe alcohol-related hepatitisRudler, MarikaHernandez-Gea, VirginiaLarrue, HélèneBouzbib, CharlotteProcopet, BogdanBaiges, AnnaGenesca, JoanVentura-Cots, MeritxellVillagrasa, AresHepatitis - TractamentVarices esofàgiquesHemorràgiaHepatitis - CirurgiaDISEASES::Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, AlcoholicDISEASES::Digestive System Diseases::Gastrointestinal Diseases::Esophageal Diseases::Esophageal and Gastric VaricesANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Anastomosis, Surgical::Portasystemic Shunt, Surgical::Portasystemic Shunt, Transjugular IntrahepaticDISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::HemorrhageENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis alcohólicaENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades del esófago::varices esofágicas y gástricasTÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::anastomosis quirúrgica::derivación portosistémica quirúrgica::derivación portosistémica intrahepática transyugularENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::hemorragiaCirrhosis; Portal hypertension; Acute variceal bleedingCirrosi; Hipertensió portal; Hemorràgia varicosa agudaCirrosis; Hipertensión portal; Hemorragia varicosa agudaBackground & Aims Severe alcohol-related hepatitis (AH) and acute variceal bleeding (AVB) may occur simultaneously. The impact of a pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) in high-risk patients (patients with Child–Pugh (CP) B and active bleeding or CP C10–13 cirrhosis) with AVB and concomitant severe AH is unknown. The objective of the study was to compare the outcomes of severe AH in patients with high-risk AVB treated with pTIPS or endoscopic and drug treatment (Endo+drugs). Methods Patients were screened in four existing cohorts of patients with cirrhosis and AVB treated either with pTIPS or Endo+drugs. The inclusion criteria were AVB, high-risk patients, suspected severe AH (recent onset of jaundice, alcohol-related liver disease, absence of abstinence, model for end-stage liver disease score >20 and aspartate aminotransferase <500 UI/L). The primary endpoint was 42-day mortality, considering liver transplantation as a competing event. Secondary endpoints were rebleeding and further development of ascites or hepatic encephalopathy at 6 months. Results A total of 142 patients with AVB were included (pTIPS: n = 47, Endo+drugs: n = 95). Baseline characteristics (age 53, male sex 84%, model for end-stage liver disease score 23.4) were similar between the two groups. Overall, 56% had histologically proven AH. The 42-day mortality was 16% in the pTIPS group vs. 30% in the Endo+drugs group (p = 0.2). The cumulative incidence of rebleeding and ascites was significantly lower in the pTIPS group (2.8% vs. 24%, p = 0.026, and 6% vs. 52%, p <0.001, respectively), whereas hepatic encephalopathy occurrence was similar in the two groups (p = 0.2). Corticosteroid therapy was given in 55% and 46% of patients in the pTIPS and Endo+drugs groups, respectively (p = 0.3). Conclusions In severe AH, pTIPS is associated with better outcomes than Endo+drugs, and should not be contraindicated. Impact and implications Severe alcohol-related hepatitis and acute variceal bleeding may occur concomitantly, yet the role of pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) placement in this setting remains unclear. In this study, compared to standard of care, pTIPS treatment was associated with lower mortality, although this difference did not reach statistical significance, as well as a significantly reduced risk of rebleeding and recurrent ascites. These findings suggest that severe alcohol-related hepatitis should not be viewed as a contraindication to pTIPS placement when otherwise indicated, such as in patients with Child–Pugh B cirrhosis with a score greater than 7 and active bleeding, or Child–Pugh C10–13 disease.ElsevierInstitut Català de la Salut[Rudler M] AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, La Pitié-Salpêtrière Hospital, Paris, France. INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. Brain-Liver Pitié-Salpêtrière Study group (BLIPS), Paris, France. [Hernandez Gea V, Baiges A] Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. [Larrue H] Service d’Hépatologie Hôpital Rangueil CHU Toulouse et Université de Toulouse, Toulouse, France. [Bouzbib C] AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, La Pitié-Salpêtrière Hospital, Paris, France. INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. [Procopet B] Department of Gastroenterology, Hospital de Sant Pau and CIBERehd, Barcelona, Spain. [Genesca J, Ventura-Cots M, Villagrasa A] Servei d’Hepatologia, Àrea de Malalties Digestives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Autonomous University of Barcelona, Barcelona, SpainVall d'Hebron Barcelona Hospital Campus202520252025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://hdl.handle.net/11351/14165Scientiareponame:Scientia. Dipòsit d'Informació Digital del Departament de Salutinstname:Consejo Superior de Investigaciones Científicas (CSIC)InglésJHEP Reports;7(12)https://doi.org/10.1016/j.jhepr.2025.101611Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:scientiasalut.gencat.cat:11351/141652026-06-12T09:38:37Z
score 15.811543

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