A randomized controlled study of early TIPS and drug combined with endoscopy in the treatment of acute variceal bleeding in patients with hepatitis B

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Acute variceal bleeding is the most common complication in patients with liver cirrhosis and portal hypertension, the treatment methods main

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Acute variceal bleeding is the most common complication in patients with liver cirrhosis and portal hypertension, the treatment methods mainly include drug therapy, combined with endoscopic meridians through internal jugular intrahepatic portosystemic shunt (TIPS), surgical diversion. At present, give priority to the use of drugs combined with endoscopy in the treatment of liver cirrhosis and acute variceal hemorrhage were recommended guidelines for the diagnosis and treatment of portal venous pressure in domestic, TIPS and surgical shunt is an ineffective treatment or help second-line treatment, but the hepatic venous pressure gradient (HVPG) in high-risk patients is greater than 20mmHg, the early application of TIPS can reduce the rate of hospitalization and treatment failure and improve the survival rate of 1 years.

A multicenter, randomized, controlled clinical trial was published in the June 2010 issue of the new England Journal of medicine. The results showed that early stent TIPS treatment of liver cirrhosis with acute variceal hemorrhage compared with standard drugs combined with endoscopic treatment can effectively control the bleeding and reduce the bleeding, can significantly improve the patient's short-term and long-term survival, and will not increase the risk of hepatic encephalopathy. In this study, the target population of early TIPS was selected for patients with cirrhosis who had grade C (less than or equal to 13) grade Child and had active bleeding under endoscopy (B). An article published, causing widespread concern and highly praised the industry. Experts believe that this, for patients with liver cirrhosis and acute variceal bleeding of liver function is poor, the so-called high-risk groups, early benefit TIPS brings beyond the possible damage, is expected to become the first-line treatment for these patients. More clinical studies are needed to confirm the results.

Recently, a clinical study on the treatment of hepatitis B cirrhosis and acute variceal Xijing Hospital of digestive diseases by Professor Han Guohong to organize the implementation of the official start bleeding. Xijing Hospital of digestive diseases of digestive has 10 years of experience of more than seven families and four families respectively in the digestion combined with drug TIPS and endoscopic treatment on portal hypertension. The clinical trial of the two departments of the joint digestion B ultrasonic room, the purpose is to compare the efficacy of these two treatment methods to identify the early application of TIPS to adapt to the crowd.

The trial was approved by the ethics committee of Xijing Hospital and was successfully registered at the National Institutes of Health sponsored clinical trial registration website. We have reason to believe that the development of this study will provide new evidence for the treatment of acute variceal bleeding in cirrhosis, especially for patients with cirrhosis in China to develop the best treatment strategy.

 

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