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DESAR module Réanimation
Digestive 2015
TIPS PRECOCE HEMORRAGIE
DIGESTIVE
Nathan Ferrand 17/12/15
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TIPS???
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J30
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� Etude prospective multicentrique randomisée
� ACLF par rupture de VO
� Child C ou B si saignement actif à l’endoscopie
� LVO ou sclérose + ttt médicale +/- TIPS dans les 72h
� CJP=Echec de contrôle hémorragie aigue et récidive saignement (1 an)
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97%
vs
50%
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86%
vs
61%
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RFE 2012
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� 58 cirrhotiques avec hémorragie digestive réfractaire….(sclérothérapie)
� Contrôle du saignement chez 52 patients=90%
� Survie 1 an 52%
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Xuefeng Luo, Radiology, July 2015
A Randomized Trial of TIPS versus Endoscopic
Band Ligation Plus Propranolol for the Prevention
of Recurrent Esophageal Variceal Bleeding
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Xuefeng Luo, Radiology, July 2015
NS sur
encéphalopathie et
mortalité
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Conclusion
�Hémorragie digestive=mauvais pronostic à court et moyen terme
�TIPS associé à une amélioration du devenir des patients
�SELECTIONNER les patients à haut risque
�TIPS vs ttt conventionnel……????