Balloon tamponade sequentially combined with TIPS for refractory acute variceal bleeding: efficacy, safety and procedure techniques

Abstract Background This study aimed to evaluate the efficacy and safety of a therapeutic strategy, balloon tamponade (BT) sequentially combined with transjugular intrahepatic portosystemic shunt (TIPS), in cirrhotic patients with refractory acute variceal bleeding (AVB), and to introduce technique points of performing TIPS under BT. Methods Fifteen consecutive patients with refractory AVB who had been treated with balloon tamponade sequentially combined with TIPS between February 2017 and November 2019 were retrospectively analyzed. We evaluated the technical success rate, efficacy and procedure-related complications, and compared pre- and post-TIPS portal pressure gradient (PPG). Variceal rebleeding, overt hepatic encephalopathy (OHE), TIPS patency was assessed periodically and survival at 6 weeks and 1 year were recorded during follow-up. Results The procedure was successfully performed in all patients. Balloon was deflated during TIPS procedure in seven patients, after TIPS in three and before TIPS in five. Mean PPG decreased from 27.7 ± 4.3 mmHg to 10.7 ± 2.8 mmHg (P < 0.001). No TIPS- and balloon-related complications were observed. Two patients died during a median follow-up of 12 months (range 1–34 months). The 6-week and 1-year survival rate was 100% and 76% respectively. The incidence of OHE was 21% (3/14). The probability of remaining free of recurrent bleeding was 100%, and the probability of maintaining TIPS patency was 100%. Conclusions Balloon tamponade sequentially combined with TIPS should be considered an effective and safe strategy for patients with refractory AVB (especially bleeding from esophageal varices). This strategy could increase bleeding control rate and reduce the incidence of procedure-related complications and rebleeding.