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Increased portal pressure during variceal bleeding may have an influence on th e treatment failure rate, as well as on short-and long-term survival. However, the usefulness of hepatic hemodynamic measurement during the acute episode has not been prospectively validated, and no information exists about the outcome of hemodynamically defined high-risk patients treated with early portal decompres sion. Hepatic venous pressure gradient (HVPG) measurement was made within the fi rst 24 hours after admission of 116 consecutive patients with cirrhosis with acu te variceal bleeding treated with a single session of sclerotherapy injection du ring urgent endoscopy. Sixty-four patients had an HVPG less than 20 mm Hg (low -risk <> group), and 52 patients had an HVPG greater than or equal to 20 mm H g (high-risk <
> group). HR patients were randomly allocated into those receiv ing trans jugular intrahepatic portosystemic shunt (TIPS; HR-TIPS group, n = 26 ) within the first 24 hours after admission and those not receiving TIPS (HR-no n-TIPS group). The HR-non-TIPS group had more treatment failures (50%vs. 12 %, P = .0001), transfusional requirements (3.7±2.7 vs. 2.2 ±2.3, P = .002), n eed for intensive care (16%vs. 3%, P < .05), and worse actuarial probability o f survival than the LR group. Early TIPS placement reduced treatment failure (12 %, P = .003), in-hospital and 1-year mortality (11%and 31%, respectively; P < .05). In conclusion, increased portal pressure estimated by early HVPG measur ement is a main determinant of treatment failure and survival in variceal bleeding, and early TIPS placement reduces treatment failure and mortality in high risk patients defined by hemodyn amic criteria. Increased portal pressure during variceal bleeding may have an influence on th e treatment failure rate, as well as on short-and long-term survival. However, the usefulness of hepatic hemodynamic measurement during the acute episode has not been prospectively validated, and no information exists about the outcome of hemodynamically defined high-risk patients treated with early portal decompresion. (HVPG) measurement was made within the fi rst 24 hours after admission of 116 consecutive patients with cirrhosis with acu te variceal bleeding treated with a single session of sclerotherapy injection du ring urgent endoscopy. Sixty-four patients had an HVPG less than 20 mm Hg (low -risk << LR >> group), and 52 patients had an HVPG greater than or equal to 20 mm Hg high-risk << HR >> group). HR patients were randomly allocated into those receiv ing trans jugular intrahepatic portosystemic shunt (TIPS; HR-TIPS group, n = 26) within the first 24 hours after adm The HR-non-TIPS group had more treatment failures (50% vs. 12%, P = .0001), transfusional requirements (3.7 ± 2.7 vs. 2.2 ± 2.3, P = .002), n eed for intensive care (16% vs. 3%, P <.05), and worse actuarial probability of survival than the LR group. = .003), in-hospital and 1-year mortality (11% and 31%, respectively; P <.05). In conclusion, increased portal pressure estimated by early HVPG measur ement is a main determinant of treatment failure and survival in variceal bleeding, and early TIPS placement reduces treatment failure and mortality in high risk patients defined by hemodyn amic criteria.
> group). HR patients were randomly allocated into those receiv ing trans jugular intrahepatic portosystemic shunt (TIPS; HR-TIPS group, n = 26 ) within the first 24 hours after admission and those not receiving TIPS (HR-no n-TIPS group). The HR-non-TIPS group had more treatment failures (50%vs. 12 %, P = .0001), transfusional requirements (3.7±2.7 vs. 2.2 ±2.3, P = .002), n eed for intensive care (16%vs. 3%, P < .05), and worse actuarial probability o f survival than the LR group. Early TIPS placement reduced treatment failure (12 %, P = .003), in-hospital and 1-year mortality (11%and 31%, respectively; P < .05). In conclusion, increased portal pressure estimated by early HVPG measur ement is a main determinant of treatment failure and survival in variceal bleeding, and early TIPS placement reduces treatment failure and mortality in high risk patients defined by hemodyn amic criteria. Increased portal pressure during variceal bleeding may have an influence on th e treatment failure rate, as well as on short-and long-term survival. However, the usefulness of hepatic hemodynamic measurement during the acute episode has not been prospectively validated, and no information exists about the outcome of hemodynamically defined high-risk patients treated with early portal decompresion. (HVPG) measurement was made within the fi rst 24 hours after admission of 116 consecutive patients with cirrhosis with acu te variceal bleeding treated with a single session of sclerotherapy injection du ring urgent endoscopy. Sixty-four patients had an HVPG less than 20 mm Hg (low -risk << LR >> group), and 52 patients had an HVPG greater than or equal to 20 mm Hg high-risk << HR >> group). HR patients were randomly allocated into those receiv ing trans jugular intrahepatic portosystemic shunt (TIPS; HR-TIPS group, n = 26) within the first 24 hours after adm The HR-non-TIPS group had more treatment failures (50% vs. 12%, P = .0001), transfusional requirements (3.7 ± 2.7 vs. 2.2 ± 2.3, P = .002), n eed for intensive care (16% vs. 3%, P <.05), and worse actuarial probability of survival than the LR group. = .003), in-hospital and 1-year mortality (11% and 31%, respectively; P <.05). In conclusion, increased portal pressure estimated by early HVPG measur ement is a main determinant of treatment failure and survival in variceal bleeding, and early TIPS placement reduces treatment failure and mortality in high risk patients defined by hemodyn amic criteria.