Timing of Transjugular Intrahepatic Portosystemic Shunts for Acute Esophagogastric Variceal Bleeding in Liver Cirrhosis

Background: Endoscopic and transjugular intrahepatic portosystemic shunt (TIPS) are the main methods for treating acute esophageal and gastric variceal bleeding (AEVB), and are also the primary measures for preventing rebleeding of AEVB in patients with liver cirrhosis. However, the optimal timing for performing TIPS has not yet been fully determined. Objectives: The aim of this study is to explore when patients can derive the maximum benefit from TIPS. Methods: To evaluate whether early TIPS can improve the prognosis of patients at risk of further bleeding or death, we divided patients with AEVB into two groups: The early TIPS treatment group and the salvage TIPS group (after failed endoscopic therapy). The primary endpoint was all-cause mortality during the follow-up period after grouping. The secondary outcome measures were the incidence of post-operative hepatic encephalopathy (HE) and rebleeding. Results: A total of 208 patients were included. During the follow-up period, the mortality rate was 13% in the early TIPS group and 15.74% in the salvage TIPS group. The rebleeding rate was 9% in the early TIPS group and 18.51% in the salvage TIPS group. Additionally, the HE rate was 22% in the early TIPS group and 35.19% in the salvage TIPS group during the follow-up period. The difference was statistically significant. Conclusions: This study demonstrates that for patients with liver cirrhosis complicated by AEVB, the early TIPS strategy is more effective in preventing rebleeding and HE without increasing the risk of mortality compared with salvage TIPS. Therefore, for eligible patients, consideration should be given to advancing the timing of TIPS intervention.