Therapy

Consider performing a porto-caval shunt ^a for patients who do not stop bleeding ^d  

Options include transjugular intrahepatic portosystemic shunts (TIPS) ^a

Why?

• TIPS is more efective than banding ^a or sclerotherapy ^a at preventing rebleeding, but causes more encephalopathy ^a and increases readmissions to hospital ^a
• There is no clear effect on mortality ^a

Varices: TIPS reduces rebleeding but increases hepatic encephalopathy compared with banding sclerotherapy

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
cirrhosis and bleeding varices a	TIPS	endoscopic banding	rebleeding at 16 months	52%	81% (42% to 94%)	2 (2 to 5)
cirrhosis and bleeding varices a	TIPS	sclerotherapy	rebleeding at 19 months	51%	54% (12% to 76%)	4 (2 to 14)
cirrhosis and bleeding varices	TIPS	sclerotherapy	moderate or severe hepatic encephalopathy at 19 months	23%	-140% (-340% to -29%)	-3 (-8 to -2)
cirrhosis and recent bleeding varices	TIPS	sclerotherapy	readmission to hospital at 2.7 years	23%	-200% (-450% to -61%)	-2 (-4 to -1)