Esophageal-gastric variceal bleeding (EGVB) represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes. Interventional therapy, a rapidly developing treatment modality over the past few years, has found widespread application in clinical practice due to its minimally invasive characteristics. However, whether transjugular intrahepatic portosystemic shunt (TIPS) treatment has an impact on patient prognosis remains controversial.

To probing the efficacy of TIPS for treating cirrhotic EGVB and its influence on the prognosis of patients afflicted by this disease.

A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022. Based on the different modes of treatment, the patients were assigned to the study group (TIPS received, n = 50) or the control group (percutaneous transhepatic varices embolization received, n = 42). Comparative analyses were performed between the two groups preoperatively and one month postoperatively for the following parameters: Varicosity status; hemodynamic parameters [portal vein flow velocity (PVV) and portal vein diameter (PVD); platelet count (PLT); red blood cell count; white blood cell count (WBC); and hepatic function [albumin (ALB), total bilirubin (TBIL), and aspartate transaminase (AST)]. The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups, and the 1-year postoperative rebleeding and survival rates were compared.

Following surgical intervention, there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts. Notably, the study group exhibited more pronounced enhancements than did the control group (P < 0.05). PVV increased, and PVD decreased compared to the preoperative values, with the study cohort achieving better outcomes (P < 0.05). PLT and WBC counts were elevated postoperatively in the two groups, with the study cohort displaying higher PLT and WBC counts (P < 0.05). No differences were detected between the two groups in terms of serum ALB, TBIL, or AST levels either preoperatively or postoperatively (P < 0.05). Postoperative scores across all dimensions of life quality surpassed preoperative scores, with the study cohort achieving higher scores (P < 0.05). At 22.00%, the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group (42.86%; P < 0.05); conversely, no marked difference was observed in the 1-year postoperative survival rate between the two cohorts (P > 0.05).

TIPS, which has demonstrated robust efficacy in managing cirrhotic EGVB, remarkably alleviates varicosity and improves hemodynamics in patients. This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.

Portal hypertension constitutes a cluster of clinical syndromes stemming from elevated pressure within the portal venous system and is primarily attributed to cirrhosis triggered by diverse factors[1]. The fundamental pathophysiological features of portal hypertension include obstruction of blood flow and/or increased blood flow in the portal venous system, augmented intravascular static pressure in the portal vein and its branches, and the formation of collateral circulation. The gastroesophageal varices (GEVs) in the gastric fundus are the predominant collateral vessels. As portal hypertension intensifies, the GEV expands and ultimately ruptures, leading to esophageal-gastric variceal bleeding (EGVB). EGVB is one of the most prevalent gastrointestinal emergencies and is a primary contributor to mortality in patients with cirrhosis[2]. Cirrhotic EGVB patients typically present with symptoms such as hematemesis and melena. Approximately 30% to 50% of cirrhosis patients succumb to this condition within six weeks following their initial esophageal variceal bleeding episode[3]. These complications pose a significant burden on global public health, leading to a severely compromised quality of life for affected individuals and an increased mortality rate. Hence, proactive exploration of treatment modalities for EGVB is highly important.

Presently, therapeutic strategies for EGVB include pharmacotherapy, triple-lumen dual-balloon catheters for pressure hemostasis, endoscopic therapy, and interventional and surgical procedures. Among these modalities, interventional treatment is highly regarded by clinical practitioners due to its straightforward procedural execution, minimal trauma, and prompt hemostatic outcomes[4]. Interventional treatments primarily include partial splenic embolization (PSE), percutaneous transhepatic variceal embolization (PTVE), balloon-occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS). Nonetheless, given the somewhat unsatisfactory progress in domestic technology at present, certain scholars have failed to allocate adequate attention to this field and tend to favor a one-sided emphasis on decompression. On the other hand, the lack of appropriate interventional equipment and the numerous complications correlated with BRTO, coupled with its limited indications, have hindered the development of PSE and BRTO within the country. Currently, PTVE and TIPS are the commonly employed interventional treatments for cirrhotic EGVB. PTVE involves percutaneous puncture of the intrahepatic portal vein branch under ultrasound guidance, followed by selective entry into variceal branches such as the coronary and short gastric veins, where embolization materials are injected to prevent bleeding and varices in the esophagus and stomach, facilitating the treatment and prevention of variceal hemorrhage. Nonetheless, PTVE is not without its drawbacks, as it is associated with the risk of exacerbating hypersplenism due to heightened portal venous pressure[5]. Conversely, TIPS establishes a shunt channel between the portal vein and hepatic vein within the liver parenchyma via the internal jugular vein, diverting blood flow from the portal venous system directly back into the systemic circulation via the channel, thus attenuating portal venous pressure[6]. In recent years, the clinical efficacy of TIPS has gained recognition because of the implementation of endovascular stent grafts and refined modulation of shunt diameters[7]. In summary, interventional treatments offer advantages such as minimal trauma, short preoperative preparation time, rapid hemostasis, and a broad range of indications. Nevertheless, there remains ongoing debate in the clinical realm regarding the impact of these two methods on liver function and prognosis in cirrhotic EGVB patients. Thus, this article endeavors to thoroughly investigate the efficacy of these two approaches.

In the context of liver cirrhosis, hepatic tissues undergo diffuse fibrosis, culminating in the impedance of portal venous drainage, augmented pressure, and the initiation of EGVB[8]. While pharmacological interventions can proficiently manage bleeding in individuals with cirrhotic EGVB, they encounter challenges in eradicating varices and are linked to extended treatment durations, thereby yielding suboptimal efficacy[9]. Endoscopic treatments fail to provide definitive resolution of recurrent bleeding among EGVB patients, and repeated interventions are often necessary, which may hinder patient acceptance[10]. Despite the efficacy of surgical procedures for managing EGVB, their application is limited by significant trauma, a heightened incidence of postoperative complications, and inapplicability to individuals with severely impaired preoperative liver function. Consequently, these factors limit the clinical utility of these methods[8]. With recent advancements in medical technology, interventional therapies have gradually been applied in the treatment of cirrhotic EGVB and have garnered significant attention from clinicians[11-13]. Consequently, the search for an effective interventional treatment modality holds substantial significance in improving patient prognosis.

TIPS placement is classified as an interventional therapy and involves the establishment of a shunt channel between the portal and hepatic veins to embolize varicose veins. This process reduces portal vein pressure and alleviates variceal severity, effectively controlling bleeding[14-16]. PTVE is also categorized as an interventional therapy that utilizes liquid embolism agents to occlude varicose veins and employs a spring coil to embolize the main trunk of the gastric coronary vein, achieving hemostasis[17-19]. In this research, the postoperative variceal conditions within the study cohort were superior to both the preoperative conditions and the control group, suggesting that TIPS may be more efficacious at ameliorating variceal conditions in patients with cirrhotic EGVB. Concerning these rationales, PTVE accomplishes hemostasis by modifying the distribution of portal vein blood flow, leading to an increase in portal vein blood flow and intensification of portal venous pressure, thereby yielding suboptimal enhancement in varicose veins. On the other hand, TIPS achieves hemostasis by establishing a shunt channel between the portal and hepatic veins, diverting a portion of blood in the portal vein into the systemic circulation. This process promotes a decrease in portal vein pressure, thereby alleviating the severity of varicose veins[20-23]. Colombato[24] reported that TIPS placement demonstrated excellent hemostatic efficacy (95%) and a low rebleeding rate (< 20%)[24]. In our work, the postoperative PVV within the study cohort was greater than both the preoperative value and the control group, whereas the PVD was lower than both the preoperative value and the control group. These findings are consistent with those of the aforementioned study, suggesting that TIPS is more effective than PTVE at improving the portal venous hemodynamics of cirrhotic EGVB patients. This may be attributed to TIPS inducing a reduction in portal veinous pressure by establishing a shunt channel, consequently abating vascular resistance and augmenting blood flow velocity. The utilization of a GORE stent enables precise control over the size of the shunt channel, thereby facilitating optimal blood flow dynamics within the channel[25-27]. Studies have shown that cirrhotic EGVB patients experience splenomegaly due to elevated portal vein pressure, which leads to hypersplenism and attenuated PLT and WBC counts and other parameters[28]. In our research, the postoperative PLT and WBC counts within the study group were greater than the preoperative values and those in the control group, suggesting that TIPS, compared to PTVE, is more effective at ameliorating the splenic function and increasing the PLT and WBC counts in cirrhotic EGVB patients. This improvement can be related to the ability of TIPS to reduce portal vein pressure, thereby alleviating or preventing hypersplenism[29-32]. Cirrhotic EGVB patients inherently suffer from impaired liver function, and the stress and inflammatory response substances elicited during and subsequent to interventional treatments need to be cleared by the liver. Hence, interventional treatments might exacerbate the burden on patients’ liver function[33]. Nonetheless, in our research, no differences were detected in the preoperative or postoperative levels of ALB, TBIL, or AST between the two cohorts, revealing that both TIPS and PTVE have certain safety profiles in the treatment of cirrhotic EGVB patients and do not significantly impact liver function. Here, the postoperative quality of life scores across all dimensions within the research cohort surpassed both the preoperative scores and those of the control group, suggesting the superior efficacy of TIPS over PTVE in enhancing the postoperative quality of life for cirrhotic EGVB patients. This improvement may be associated with TIPS being more effective at mitigating the severity of varices and bolstering recovery[34-36]. Furthermore, our investigation revealed a 22.00% rebleeding rate within the research cohort at the one-year mark, in contrast with the 42.86% rate observed in the control group. This finding implies that TIPS is more effective than PTVE at reducing the one-year postoperative rebleeding rate in cirrhotic EGVB patients. This effect may be related to the improvement in portal venous pressure and hemodynamics achieved by TIPS. Additionally, our study revealed no substantial difference in one-year postoperative survival rates between the two cohorts, indicating a favorable prognosis for both TIPS and PTVE in the treatment of patients afflicted by cirrhotic EGVB.

In summary, in the management of EGVB in cirrhotic patients, TIPS placement is an effective and safe therapeutic option. It dramatically mitigates the severity of varices and hemodynamics, aiding cirrhotic patients in alleviating their condition, averting the onset of complications, elevating the quality of life, and attaining superior treatment outcomes. Our study established a theoretical foundation for advocating TIPS as a primary intervention for patients afflicted with cirrhosis complicated by EGVB. However, it is essential to acknowledge the limitations inherent in our investigation. First, this study adopted a retrospective design rather than a randomized controlled trial, thereby introducing the potential for selection bias and confounding factors. Second, the absence of long-term follow-up data represents a notable limitation, as sustained observation is imperative for comprehending alterations in patient survival and quality of life in the context of TIPS treatment.