GI BLEED IN CIRRHOSIS- How Interventional Radiologist Can help

Interventional radiology in Cirrhosis

1. FIXING THE LEAK ROLE OF IR IN CIRRHOTIC VARICEAL BLEEDS

2. VARICEAL BLEEDING ESOPHAGEAL GASTRIC ECTOPIC CECT- TRIPLE PHASE

3. BRTO TIPSS

4. TIPSS BRTO

5. Case Scenario 1 21 year old referred from Malappuram with recurrent high volume hematemesis On evaluation he was diagnosed of cirrhosis with portal hypertension On endoscopic evaluation he had large gastric varices and endoscopic glue injection

6. CASE SCENARIO 2 66 year old man DECOMPENSATED CHRONIC LIVER DISEASE CHILD B (9) MELD Na 18 Bleeder ( OGDscopy - Grade 4 Esophageal Varices. S/P EVL. Severe Portal Gastropathy Jaundice + No Ascites/HE/HCC/HPS/HRS No PVT

7. TIPSS VS BRTO TIPS aims to decrease the portal pressure to reduce gastric variceal bleeding  BRTO scleroses the GV without decreasing portal pressure TIPS changes the haemodynamics of the portal vein- On the contrary, some blood that has not been metabolized by the liver directly enters the systemic circulation and might lead to azotaemia , which in turn leads to hepatic encephalopathy and hepatic myelopathy .   BRTO directly stops bleeding without reducing portal pressure, which may increase the risk of ascites and bacterial peritonitis

8. The overall survival rate and rebleeding rate in the BRTO group were significantly higher than those in the TIPS group Except for the post procedure complications (hepatic encephalopathy), the TIPS group and BRTO group did not have a significant difference in the immediate haemostasis rate, which meant that the two methods were both effective for GVB in emergency situations.

9. Rebleeding rate: BRTO> TIPS Hepatic encephalopathy : TIPS > BRTO Ascites: BRTO > TIPS Immediate hemostasis rate: TIPS = BRTO Technical success rate : TIPS> BRTO Change in CTP Score : TIPS = BRTO Overall survival rate : BRTO > TIPS

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