Description of Portal Hypertension Treatment by Transjugular Intrahepatic Portosystemic Shunt: A French National Hospital Database Analysis

OBJECTIVES: Cirrhosis is the main cause of portal hypertension (PH), leading to ascites and/or variceal bleeding with a significant impact on patient’s survival. The main objectives of the study are to describe the hospital management of PH treatment by transjugular intrahepatic portosystemic shunt (TIPS) and estimate the burden of ascites and variceal bleeding recurrence.

METHODS: This population-based retrospective cohort study was performed using the French exhaustive national hospital discharge database (PMSI). Patients who had hospitalization for a TIPS procedure according to the French procedures classification (CCAM) between January 1, 2018 and December 31, 2020 were included. Each patient included before December 31, 2019, was followed-up for one year after cohort entry date and additional hospitalizations for ascites or variceal bleeding treatments were retrieved, combining diagnosis and procedure codes: ascites and large volume paracentesis (LVP); variceal bleeding and endoscopic band ligation (EBL).

RESULTS: 2,475 patients were hospitalized between 2018 and 2020 for a TIPS procedure. The mean age of patients was 58.7 ± 10.7 years old; 76.4% of them were males. 1,401 (56.6%) presented with ascites, and 1,280 (51.7%) with variceal bleeding. 81.7% were treated with a GORE® VIATORR® TIPS Endoprosthesis with Controlled Expansion. Mean length of stay (LOS) was 13.5 ± 21.2 days. Overall survival was 68.2% at one year and 56.0% at two years. Among the 1,690 patients included before December 31, 2019, 518 (20.9%) were re-hospitalized for LVP within 114 days on average and 103 (4.2%) for EBL within 215 days on average.

CONCLUSIONS: This study confirms the interest of TIPS treatment on PH complications in France, with an impact on LVPs and EBLs. Given the forthcoming increase in cirrhosis, it highlights the need to refer more patients to earlier/preemptive TIPS in line with international guidelines, to reach expected survival.