{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T04:34:38Z","timestamp":1773549278457,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,8,22]],"date-time":"2018-08-22T00:00:00Z","timestamp":1534896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Foundation for Liver and Gastrointestinal Research Rotterdam"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2018,11]]},"abstract":"Summary<\/jats:title>Background<\/jats:title>Evidence for the efficacy of TIPSS<\/jats:styled-content> in ectopic variceal bleeding (EctVB<\/jats:styled-content>) is largely based on relatively small series.<\/jats:p><\/jats:sec>Aim<\/jats:title>To define the efficacy of TIPSS<\/jats:styled-content> in EctVB<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>Retrospective analysis of consecutive patients with chronic liver disease who presented with EctVB<\/jats:styled-content> and received TIPSS<\/jats:styled-content> in three tertiary centres in 1992\u20102016.<\/jats:p><\/jats:sec>Results<\/jats:title>The study included 53 patients (70% male, median age 61\u00a0years, median model for end\u2010stage liver disease (MELD<\/jats:styled-content>) score 11). The ectopic varices were located around the insertion of stomas (40%), duodenum (23%), rectum (17%) and at other sites (20%). Three\u2010quarters of the patients had previously received unsuccessful medical, endoscopic or surgical therapy. The median follow\u2010up was 14.0\u00a0months. Following TIPSS<\/jats:styled-content>, bleeding recurred in 12 patients: 6 of 12 (50%) with duodenal varices, 2 of 9 (22%) with rectal varices and one each with stomal (1\/21), intraperitoneal (1\/3), hepaticojejunostomy (1\/2) and ascending colon varices (1\/2). The risk factors for re\u2010bleeding were MELD<\/jats:styled-content> score at TIPSS<\/jats:styled-content> placement (HR<\/jats:styled-content>: 1.081 per point; 95% confidence interval (CI<\/jats:styled-content>): 1.012\u20101.153; P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.034), varices located at site other than an enterostomy (HR<\/jats:styled-content>: 9.770; 95%CI<\/jats:styled-content>: 1.241\u201076.917; P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.030) and previous local therapy (HR<\/jats:styled-content>: 5.710; 95%CI<\/jats:styled-content>: 1.211\u201026.922; P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.028). The estimated cumulative re\u2010bleeding rate was 23% at 1\u00a0year, 26% at 3\u00a0years and 32% at 5\u00a0years. Post\u2010TIPSS<\/jats:styled-content> hepatic encephalopathy manifested or worsened in 16 of 53 patients (30%).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>TIPSS<\/jats:styled-content> provides long\u2010term control of bleeding in most cirrhotic patients with EctVB<\/jats:styled-content>. TIPSS<\/jats:styled-content> is particularly effective in stomal EctVB<\/jats:styled-content>, the most frequent cause of EctVB<\/jats:styled-content>, but might not be as effective in duodenal EctVB<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.14947","type":"journal-article","created":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T06:55:07Z","timestamp":1535007307000},"page":"975-983","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1032-495X","authenticated-orcid":false,"given":"Rosalie C.","family":"Oey","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus MC University Medical Center Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koos","family":"de Wit","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Academic Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9503-788X","authenticated-orcid":false,"given":"Adriaan","family":"Moelker","sequence":"additional","affiliation":[{"name":"Department of Radiology Erasmus MC University Medical Center Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tugce","family":"Atalik","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus MC University Medical Center Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3342-9367","authenticated-orcid":false,"given":"Otto M.","family":"van Delden","sequence":"additional","affiliation":[{"name":"Department of Radiology Academic Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0598-0258","authenticated-orcid":false,"given":"Geert","family":"Maleux","sequence":"additional","affiliation":[{"name":"Department of Radiology University Hospitals Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9370-6832","authenticated-orcid":false,"given":"Nicole S.","family":"Erler","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Erasmus MC University Medical Center Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2179-1385","authenticated-orcid":false,"given":"R. Bart","family":"Takkenberg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Academic Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"de Man","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus MC University Medical Center Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2905-5112","authenticated-orcid":false,"given":"Frederik","family":"Nevens","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospitals Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1299-0553","authenticated-orcid":false,"given":"Henk R.","family":"van Buuren","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus MC University Medical Center Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,8,22]]},"reference":[{"issue":"1","key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S0300-5089(21)00639-8","article-title":"Ectopic varices in portal hypertension","volume":"14","author":"Lebrec D","year":"1985","journal-title":"Clin Gastroenterol"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-008-9074-1"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(81)90077-9"},{"key":"e_1_2_7_5_1","first-page":"111","volume-title":"Studies in portal hypertension","author":"Van Buuren HR","year":"2002"},{"issue":"4","key":"e_1_2_7_6_1","first-page":"301","article-title":"Operative morbidity after shunt surgery for portal hypertension","volume":"70","author":"Fegiz G","year":"1985","journal-title":"Int Surg"},{"issue":"5","key":"e_1_2_7_7_1","first-page":"868","article-title":"Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy","volume":"114","author":"Abu\u2010Elmagd KM","year":"1993","journal-title":"Surgery"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(86)90260-6"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.1997.156331000.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.191.1.8134568"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.51.2.270"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2004.06.024"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-004-0346-4"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2008.03719.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.03.018"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60383-9"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2001.22172"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2003.50016"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0910102"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.06.004"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2016152641"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12934"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-016-4570-5"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28318"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2003.11.016"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2007.01522.x"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1665-2681(19)31277-3"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.06.014"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13809"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.05.006"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2014.08.012"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2016.06.023"}],"container-title":["Alimentary Pharmacology & Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fapt.14947","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.14947","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T21:30:33Z","timestamp":1694295033000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.14947"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,22]]},"references-count":31,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1111\/apt.14947"],"URL":"https:\/\/doi.org\/10.1111\/apt.14947","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,22]]},"assertion":[{"value":"2018-05-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}