Charles A. Owens, MD
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Owens C.; Transesophageal Intrahepatic Portosystemic Shunts Compared with Sclerotherapy. Ann Intern Med. 1998;128:71-72. doi: 10.7326/0003-4819-128-1-199801010-00017
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Published: Ann Intern Med. 1998;128(1):71-72.
TO THE EDITOR:
My colleagues and I were pleased to see the prospective studies by Sanyal  and Cello  and their colleagues comparing transjugular intrahepatic portosystemic shunts with endoscopic sclerotherapy for the control of variceal bleeding. We were disturbed, however, to see such a high incidence of recurrent variceal hemorrhage in the TIPS populations. In Sanyal and colleagues' group, 9 of the 39 patients who had a TIPS placed returned with variceal hemorrhage. Six of the 9 patients died of their variceal bleeding.
We believe that a 23% rate of recurrent variceal bleeding within 1000 days after TIPS is unacceptably high and is probably related to the manner in which the patency of the intrahepatic shunt was assessed. Although current reports have suggested that Doppler ultrasonography is sensitive in detecting hemodynamically significant intrahepatic shunt stenosis and occlusions, the accuracy of this method has never been proven in a prospective, double-blinded study using preset ultrasonographic criteria.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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