- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02119988
TIPS Combined With Variceal Embolization for the Prevention of Variceal Rebleeding in Patients With Cirrhosis
Transjugular Intrahepatic Portosystemic Shunt (TIPS) Using Covered Stents Combined With Variceal Embolization in the Prevention of Variceal Rebleeding for Patients With Cirrhosis : a Prospective, Open-labeled, Randomized, Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Variceal bleeding is one of the leading causes of death in patients with cirrhosis. Patients with cirrhosis surviving a variceal bleeding are at high risk of rebleeding (over 60% at 1 year), and mortality from each rebleeding episode is about 20%.
Placement of TIPS is a well-established technique that is highly effective in preventing recurrent variceal bleeding, especially if the TIPS is created with an expanded polytetrafluoroethylene (ePTFE)-covered stent, which has a significantly lower risk of shunt dysfunction than does TIPS created with bare stents. But the risk of hepatic encephalopathy greatly increases and the risk of recurrent variceal bleeding after TIPS placement remains an issue. Besides an insufficient decrease in portosystemic pressure gradient after TIPS creation alone, fragile variceal vessels also are considered a risk factor for recurrent bleeding.
Accordingly, TIPS combined with variceal embolization has been advocated to achieve the best result possible in preventing recurrent variceal bleeding. However, in recent American Association of the Study of Liver Disease (AASLD) practice guidelines and Baveno V consensus, no treatment strategies were clearly recommended maybe because the exact efficacy of this strategy remains unclear and high-quality randomized controlled trials still lacks.
So the investigators hypothesized that embolization of these collateral vessels may increase the blood flow within the shunt and into the liver, which can theoretically decrease the incidence of shunt dysfunction and encephalopathy, even can prolong the patients' survival.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Shaanxi
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Xi'an, Shaanxi, China, 710032
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University
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Xi'an, Shaanxi, China, 710032
- Xijing Hospital of digestive disease, Fourth Military Medical University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Signed written informed consent
- Dignosis of cirrhosis (clinical or by liver biopsy)
- Admission due to variceal bleeding occurred 5 to 42 days prior and standard treatment for secondary prophylaxis failed
- Age 18 to 75 years
Exclusion Criteria:
- Hepatic carcinoma and/or other malignancy diseases
- Portal vein thrombosis (≥50% of the lumen)
- Child-Pugh score>13 points
- Spontaneous recurrent hepatic encephalopathy
- Budd-Chiari syndrome
- Large spontaneous portosystemic shunts
- Sepsis
- Spontaneous bacterial peritonitis
- Uncontrollable hypertension
- Serious cardiac or pulmonary dysfunction
- Renal failure
- With TIPS contraindications
- Previous TIPS or collateral embolization,
- Pregnancy or breast-feeding
- History of organ transplantation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: TIPS combined with variceal embolization
The covered stents will be used for TIPS The gastroesophageal collaterals will be embolized during the procedure of TIPS |
TIPS will be performed with a standard technique.
TIPS revision will be planned if any evidence of shunt dysfunction is observed.
Embolization of gastroesophageal collaterals will be conducted via the same jugular vein before TIPS implantation.
The major procedures includ (a) angiography of gastroesophageal collaterals after successful intrahepatic puncture of a branch of the portal vein and (b) embolization of gastroesophageal collaterals with coils of varying diameters, which result in the gastroesophageal collaterals disappearing at postembolization angiography.
|
Active Comparator: TIPS alone
The covered stents will be used for TIPS No embolization of any collateral will be performed during TIPS |
TIPS will be performed with a standard technique.
TIPS revision will be planned if any evidence of shunt dysfunction is observed.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
All-cause rebleeding
Time Frame: 2 years
|
2 years
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Mortality
Time Frame: 2 years
|
2 years
|
Adverse events
Time Frame: 2 years
|
2 years
|
Variceal rebleeding
Time Frame: 2 years
|
2 years
|
Shunt dysfunction
Time Frame: 2 years
|
2 years
|
Hepatic encephalopathy
Time Frame: 2 years
|
2 years
|
Liver function changs
Time Frame: 2 years
|
2 years
|
Collaborators and Investigators
Investigators
- Principal Investigator: Guohong Han, PhD & MD, Xijing Hospital of Digestive Diseases, Fourth Military Medical University
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- TIPS-Variceal embolization
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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