Portal Hypertensive Gastropathy and MELD-Na Score Predict Recurrent Gastrointestinal Bleeding After TIPSS: An ALTA Group Study

Kelly Hu; Mai Sedki; Allison Kwong; Andrew Kesselman; Kanti Pallav Kolli; Giuseppe Morelli; Erin Spengler; Adnan Said; Jennifer Lai; Archita Desai; Sonali Paul; Catherine Frenette; Michael Fallon; Margarita German; Elizabeth Verna; Justin Boike; Dyanna Gregory; Bartley Thornburg; Lisa VanWagner; Aparna Goel; Advancing Liver Therapeutic Approaches (ALTA) Study Group

doi:10.1111/apt.18362

Portal Hypertensive Gastropathy and MELD-Na Score Predict Recurrent Gastrointestinal Bleeding After TIPSS: An ALTA Group Study

Aliment Pharmacol Ther. 2024 Nov 5. doi: 10.1111/apt.18362. Online ahead of print.

Authors

Kelly Hu¹, Mai Sedki¹, Allison Kwong¹, Andrew Kesselman², Kanti Pallav Kolli³, Giuseppe Morelli⁴, Erin Spengler⁵, Adnan Said⁶, Jennifer Lai⁷, Archita Desai⁸, Sonali Paul⁹, Catherine Frenette¹⁰, Michael Fallon¹¹, Margarita German⁶, Elizabeth Verna¹², Justin Boike¹³, Dyanna Gregory¹³, Bartley Thornburg¹⁴, Lisa VanWagner¹⁵, Aparna Goel¹; Advancing Liver Therapeutic Approaches (ALTA) Study Group

Affiliations

¹ Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA.
² Department of Radiology, Division of Interventional Radiology, Stanford University, Stanford, California, USA.
³ Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
⁴ University of Florida Health, Gainesville, Florida, USA.
⁵ Division of Gastroenterology, Department of Medicine, University of Texas Health-San Antonio, San Antonio, Texas, USA.
⁶ Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁷ Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, California, USA.
⁸ Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁹ Department of Internal Medicine, Section of Gastroenterology, Hepatology, and Nutrition, The University of Chicago Medicine, Chicago, Illinois, USA.
¹⁰ Department for Organ and Cell Transplantation, Scripps Clinic, La Jolla, California, USA.
¹¹ Divison of Gastroenterology and Hepatology, Department of Medicine, Banner University Medical Center, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA.
¹² Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
¹³ Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁴ Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁵ Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

PMID: 39501554
DOI: 10.1111/apt.18362

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPSS) is highly effective for treatment of variceal bleeding; however, factors contributing to rebleeding complications remain unclear.

Aims: In this study, we aim to determine risk factors for recurrent portal hypertensive gastrointestinal bleeding following TIPSS.

Methods: Utilising the Advancing Liver Therapeutic Approaches multicentre database, we retrospectively identified adult patients who underwent TIPSS for secondary prophylaxis of variceal bleeding and had a gastrointestinal rebleeding event within 1 year. We developed multivariable logistic regression models to identify clinical/procedural characteristics associated with rebleeding.

Results: We identified 476 patients, predominately middle-aged (mean age 57), male (62%) and White (65%), with mean MELD-Na 16. 16% (n = 77) had a rebleeding event; these patients were more likely to be male (p = 0.016), with higher serum creatinine (p = 0.005), MELD-Na (p = 0.0002), portal hypertensive gastropathy on pre-TIPSS upper endoscopy (p = 0.000) and with higher incidence of TIPSS revision (p = 0.000). There were no significant differences in type of TIPSS endoprosthesis, concurrent embolotherapy, and post-TIPSS pressure gradients between those who experienced rebleeding and those who did not. After adjusting for TIPSS revision, multivariable analysis revealed MELD-Na and presence of portal hypertensive gastropathy on pre-TIPSS endoscopy were independently associated with rebleeding.

Conclusions: In this retrospective analysis of a multicentre, nationally representative database, we found that apart from TIPSS-related factors, high MELD-Na and portal hypertensive gastropathy on pre-TIPSS endoscopy were independent predictors of rebleeding within 1 year following TIPSS. These variables may be used to identify high-risk patients who may require additional monitoring following TIPSS.

Keywords: TIPSS; ascites; cirrhosis; portal hypertension; variceal haemorrhage.