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Management of Ectopic Variceal Bleeding With Transjugular Intrahepatic Portosystemic Shunt: A Systematic Review of Case Reports Publisher Pubmed



Ghadimi DJ1 ; Ghorani H1, 2 ; Moradi Z3 ; Golezar MH2, 4 ; Nouri S5 ; Irilouzadian R6 ; Zare Dehnavi A7 ; Ebrahimi P8 ; Ghasemi Rad M9
Authors
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Authors Affiliations
  1. 1. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
  3. 3. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran
  5. 5. Department of Radiology, School of Medicine Arak, University of Medical Sciences, Arak, Iran
  6. 6. Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, 55905, MN, United States
  8. 8. Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  9. 9. Department of Interventional Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, 77030, TX, United States

Source: Emergency Radiology Published:2024


Abstract

Ectopic varices account for 5% of variceal bleedings and occur outside the gastro-esophageal region. This review evaluates the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for ectopic variceal management. A comprehensive search through PubMed, Scopus, Web of Science, and Embase was conducted until January 16, 2023, using relevant keywords. Case reports and case series with fewer than 10 patients on TIPS for ectopic variceal management were included. The quality assessment followed the Joanna Briggs Institute checklist for case reports. This systematic review evaluated 43 studies involving 50 patients with ectopic varices undergoing TIPS. Patients had a mean age of 54.3 years, half were female, and two were pregnant. Alcoholic liver disease (48%) and hepatitis C infection (26%) were common causes of portal hypertension. Ascites and splenomegaly were reported in 32% and 28% of the patients, respectively. Rectal, oral, and stomal variceal bleeding accounted for 62%, 16%, and 22% of the patients, respectively. Ectopic varices were mainly located in the duodenum (28%) and rectum (26%) regions. Complications affected 42% of the patients, re-bleeding in eleven and hepatic encephalopathy in seven. The follow-up lasted 12 months on average, and finally, 5 received a liver transplant. Mortality post-TIPS was 18%. Despite complications and a notable mortality rate, favorable outcomes were observed in almost half of the patients with ectopic variceal bleeding managed with TIPS. Further research is warranted to refine strategies and improve patient outcomes. Graphical Abstract: (Figure presented.) © The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER) 2024.
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