Clinical study on hepatic venous pressure gradient in TIPS versus EVL for bleeding due to esophagogastric varices secondary to liver cirrhosis

doi:10.3877/cma.j.issn.1674-3946.2026.04.009

Abstract

Abstract:

Objective

To investigate the clinical value of hepatic venous pressure gradient (HVPG) in transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic variceal ligation (EVL) for the treatment of cirrhotic esophagogastric variceal bleeding.

Methods

A retrospective cohort study was conducted. A total of 152 patients diagnosed with cirrhotic esophagogastric variceal bleeding and receiving corresponding treatment from January 2022 to December 2024 were enrolled. The patients were divided into the TIPS group (n=74) and the EVL group (n=78) according to the actual intervention measures. The chi-square test and t-test were used to compare primary efficacy endpoints (including preoperative HVPG level, postoperative HVPG change amplitude, pressure reduction compliance rate and immediate hemostasis success rate) and secondary efficacy endpoints (1-year cumulative rebleeding rate, 1-year cumulative survival rate and median time to rebleeding) between the two groups. Perioperative indicators were also compared. P<0.05 was considered statistically significant.

Results

The total procedural time, puncture/ligation time and sedation/anesthesia time in the TIPS group were significantly longer than those in the EVL group, with more intraoperative blood loss and higher dosage of sedatives. The 24-hour postoperative Visual Analogue Scale (VAS) pain score of the TIPS group was markedly lower than that of the EVL group (P<0.001). Statistically significant differences were observed in postoperative HVPG, absolute HVPG reduction and HVPG reduction rate between the two groups (P<0.001). Among patients with successful pressure reduction, the TIPS group presented a lower 1-year cumulative rebleeding rate, higher survival rate and longer median time to rebleeding (P<0.05). For patients with failed pressure reduction, the TIPS group had a higher 1-year cumulative rebleeding rate, lower survival rate and shorter median time to rebleeding (P<0.05). Significant differences were found between the two groups in the incidence of postoperative complications including hepatic encephalopathy, stent stenosis/occlusion, esophageal ulcer/stenosis and recurrent varices (P<0.05).

Conclusion

The improvement of HVPG after TIPS and EVL is directly correlated with the risk of postoperative rebleeding. TIPS is technically demanding, but it shows superior performance in long-term rebleeding prevention and survival benefit. EVL is simple to perform but associated with a higher long-term rebleeding risk. Therefore, TIPS is recommended for patients with elevated HVPG who require long-term reduction of rebleeding risk. EVL is preferable for patients with relatively low HVPG, intolerance to prolonged procedures and acceptance of short-term local complication risks.

Key words: Cirrhotic Esophagogastric Variceal Bleeding, Hepatic Venous Pressure Gradien, Transjugular Intrahepatic Portosystemic Shunt, Endoscopic Variceal Ligation, Clinical Efficacy

Tao Liu, Bei Feng, Xiaoyong Li. Clinical study on hepatic venous pressure gradient in TIPS versus EVL for bleeding due to esophagogastric varices secondary to liver cirrhosis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(04): 331-336.

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Figures/Tables 5

组别	例数	性别（例）	年龄（岁, $x ¯$ ±s）	BMI（kg/m², $x ¯$ ±s）	肝硬化病因（例）
组别	例数	男/女	年龄（岁, $x ¯$ ±s）	BMI（kg/m², $x ¯$ ±s）	A/B/C/D
TIPS组	74	40/34	62.3±8.4	23.7±1.6	28/15/18/13
EVL组	78	44/34	61.8±7.8	23.8±1.9	30/16/19/13
统计值		χ²=0.085	t=0.425	t=0.276	χ²=0.023
P值		0.770	0.671	0.283	0.994
组别	Child-Pugh分级（例）	MELD评分（分, $x ¯$ ±s）	术前氧疗时间（h, $x ¯$ ±s）
组别	A/B/C	MELD评分（分, $x ¯$ ±s）	术前氧疗时间（h, $x ¯$ ±s）
TIPS组	22/38/14	12.3±2.5	6.3±2.2
EVL组	24/40/14	12.2±2.4	6.1±2.1
统计值	Z=0.033	t=0.384	t=0.379
P值	0.984	0.702	0.705

组别	例数	性别（例）	年龄（岁, $x ¯$ ±s）	BMI（kg/m², $x ¯$ ±s）	肝硬化病因（例）
组别	例数	男/女	年龄（岁, $x ¯$ ±s）	BMI（kg/m², $x ¯$ ±s）	A/B/C/D
TIPS组	74	40/34	62.3±8.4	23.7±1.6	28/15/18/13
EVL组	78	44/34	61.8±7.8	23.8±1.9	30/16/19/13
统计值		χ²=0.085	t=0.425	t=0.276	χ²=0.023
P值		0.770	0.671	0.283	0.994
组别	Child-Pugh分级（例）	MELD评分（分, $x ¯$ ±s）	术前氧疗时间（h, $x ¯$ ±s）
组别	A/B/C	MELD评分（分, $x ¯$ ±s）	术前氧疗时间（h, $x ¯$ ±s）
TIPS组	22/38/14	12.3±2.5	6.3±2.2
EVL组	24/40/14	12.2±2.4	6.1±2.1
统计值	Z=0.033	t=0.384	t=0.379
P值	0.984	0.702	0.705

组别	例数	总操作时间（min）	穿刺/套扎时间（min）	镇静/麻醉时间（min）	术中出血量（ml）	术中镇静药物用量（mg）
TIPS组	74	85.3±12.6	18.6±5.1	95.5±15.4	44.7±8.2	15.3±3.5
EVL组	78	25.5±5.9	12.4±3.5	30.2±6.8	10.3±3.5	8.9±2.1
t值		37.740	8.721	34.134	34.167	13.754
P值		<0.001	<0.001	<0.001	<0.001	<0.001
组别	术后24 h VAS疼痛评分（分）	术后24 h 血红蛋白下降值（g/dl）	术后48 h最高体温（℃）	术后24 h血肌酐变化值（μmol/L）
TIPS组	3.5±1.2	1.2±0.5	37.5±0.4	5.3±3.1
EVL组	5.7±1.9	1.2±0.4	37.6±0.5	4.9±3.0
t值	8.619	0.769	0.966	0.730
P值	<0.001	0.443	0.335	0.467

组别	例数	即时止血成功[例（%）]	术前HVPG（mmHg, $x ¯$ ±s）	术后72 h HVPG（mmHg, $x ¯$ ±s）	HVPG绝对降幅（mmHg, $x ¯$ ±s）	HVPG下降率（%, $x ¯$ ±s）	减压达标[例（%）]
TIPS组	74	73(98.7)	18.3±3.1	10.1±2.1	8.1±1.9	44.6±8.2	68(91.9)
EVL组	78	72(92.3)	17.9±3.1	15.4±2.9	2.6±1.2	14.5±6.4	22(28.2)
统计值		χ²=2.182	t=0.617	t=12.712	t=21.513	t=25.155	χ²=63.773
P值		0.140	0.534	<0.001	<0.001	<0.001	<0.001
组别	1年累计再出血-减压达标[例（%）]	1年累计再出血-减压未达标[例（%）]	1年累计生存-减压达标[例（%）]	1年累计生存-减压未达标[例（%）]	再出血中位时间-减压达标[月, M(Q₁,Q₃)]	再出血中位时间-减压未达标[月, M(Q₁,Q₃)]
TIPS组	6(8.8)	3(50.0)	63(92.7)	4(66.7)	20.2(18.7,21.6)	7.8(6.4,9.12)
EVL组	3(13.6)	24(42.9)	19(86.4)	42(75.0)	15.3(14.0,16.6)	12.1(10.0,14.2)
统计值	-	-	χ²=7.550	-	Z=28.621	Z=3.279
P值	<0.001	<0.001	0.006	0.006	<0.001	0.003

组别	例数	即时止血成功[例（%）]	术前HVPG（mmHg, $x ¯$ ±s）	术后72 h HVPG（mmHg, $x ¯$ ±s）	HVPG绝对降幅（mmHg, $x ¯$ ±s）	HVPG下降率（%, $x ¯$ ±s）	减压达标[例（%）]
TIPS组	74	73(98.7)	18.3±3.1	10.1±2.1	8.1±1.9	44.6±8.2	68(91.9)
EVL组	78	72(92.3)	17.9±3.1	15.4±2.9	2.6±1.2	14.5±6.4	22(28.2)
统计值		χ²=2.182	t=0.617	t=12.712	t=21.513	t=25.155	χ²=63.773
P值		0.140	0.534	<0.001	<0.001	<0.001	<0.001
组别	1年累计再出血-减压达标[例（%）]	1年累计再出血-减压未达标[例（%）]	1年累计生存-减压达标[例（%）]	1年累计生存-减压未达标[例（%）]	再出血中位时间-减压达标[月, M(Q₁,Q₃)]	再出血中位时间-减压未达标[月, M(Q₁,Q₃)]
TIPS组	6(8.8)	3(50.0)	63(92.7)	4(66.7)	20.2(18.7,21.6)	7.8(6.4,9.12)
EVL组	3(13.6)	24(42.9)	19(86.4)	42(75.0)	15.3(14.0,16.6)	12.1(10.0,14.2)
统计值	-	-	χ²=7.550	-	Z=28.621	Z=3.279
P值	<0.001	<0.001	0.006	0.006	<0.001	0.003

组别	例数	减压（例）	术式选择（例）	术后HVPG（mmHg, $x ¯$ ±s）
组别	例数	达标/未达标	TIPS/EVL	术后HVPG（mmHg, $x ¯$ ±s）
再出血组	36	9/27	9/27	14.1±2.8
未出血组	116	81/35	65/51	12.4±2.5
统计值		χ²=22.859	χ²=10.592	t=3.366
P值		<0.001	0.001	0.001
组别	HVPG绝对降幅（mmHg, $x ¯$ ±s）	HVPG下降率（%, $x ¯$ ±s）	术前HVPG（mmHg, $x ¯$ ±s）
再出血组	4.0±2.0	22.1±6.9	18.0±3.1
未出血组	5.7±1.6	31.4±7.5	18.1±3.1
统计值	t=5.214	t=6.639	t=0.152
P值	<0.001	<0.001	0.879

组别	例数	减压（例）	术式选择（例）	术后HVPG（mmHg, $x ¯$ ±s）
组别	例数	达标/未达标	TIPS/EVL	术后HVPG（mmHg, $x ¯$ ±s）
再出血组	36	9/27	9/27	14.1±2.8
未出血组	116	81/35	65/51	12.4±2.5
统计值		χ²=22.859	χ²=10.592	t=3.366
P值		<0.001	0.001	0.001
组别	HVPG绝对降幅（mmHg, $x ¯$ ±s）	HVPG下降率（%, $x ¯$ ±s）	术前HVPG（mmHg, $x ¯$ ±s）
再出血组	4.0±2.0	22.1±6.9	18.0±3.1
未出血组	5.7±1.6	31.4±7.5	18.1±3.1
统计值	t=5.214	t=6.639	t=0.152
P值	<0.001	<0.001	0.879

组别	例数	肝性脑病	支架狭窄/闭塞	食管溃疡/狭窄	静脉曲张再发	感染
TIPS组	74	11(14.9)	7(9.5)	0	2(2.7)	4(5.4)
EVL组	78	0	0	16(20.5)	19(24.4)	2(2.6)
P值		<0.001	0.018	<0.001	<0.001	0.630

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