To observe feasibility and efficacy of the modified TIPS in treatment of gastro-esophageal bleeding.

A total of 56 patients with gastro-esophageal bleeding underwent modified TIPS. Puncture the right internal jugular vein under the guidance of ultrasound, push the Rups-100 to the right hepatic vein along the guide wire, after successful puncture through hepatic vein to portal vein, a stiff wire was exchanged and a balloon (8 mm×40 mm) was sent and inflated across the liver parenchymal. A bare stent (8 mm×60 mm) was released through the track, and a stent-graft (8 mm×40 mm) was released within the bare stent according to the markers on the balloon. The stent-graft must cover the liver parenchymal track. Gastric coronary veins were emblazed with coils routinely. The portal pressure were measured before and after the shunt established.

Of all 56 cases were technically successful (100%). The portal pressure fell to (17.36±3.48)mmHg from (31.20±3.98)mmHg. All patients were followed up from 1 to 3 years. The decrease of portal vein pressure pre- and post-TIPS was statistically significant (t=40.062, P<0.001). During the period of 1—3 years follow-up, the shunts patency rate was 89.3%, 75.0%, 67.8% and the rate of rebleeding was 7.1%, 12.5%, 16.1% respectively; the rate of encephalopathy was 12.5%. One case accepted antibiotics treatment because of sepsis; 7 cases underwent re-TIPS due to the shunt occlusion. No other procedure related complications occured. Five cases died of hepatic failure, hepatocellular carcinoma and multiple organ failure.

The modified TIPS with bare stent combined with stent-graft can effectively improve the patency rate of shunt, decrease the rate of rebleeding, and reduce complications related to technique through simplifying the procedure.