P76 Retrospective review of outcomes following radiological intervention in non-cirrhotic and cirrhotic portal hypertensive variceal bleeding

<h3>Introduction</h3> Acute variceal bleeding (AVB) management is well studied¹²³, particularly in cirrhotic patients. When endoscopic haemostasis is not achieved, interventional radiology (IR) options such as transjugular intrahepatic portosystemic shunts (TIPSS), variceal embolisation, and splenic embolisation are often employed. We reviewed outcomes in the largest referral centre in the west of Scotland for both cirrhotic and non-cirrhotic portal hypertensive bleeding. <h3>Methods</h3> IR cases for AVB, categorized under ‘embolisation’ and ‘TIPSS’, were identified from the PACS system between January 2022 and October 2024. Data was collected from digital records on interventions, demographics, cirrhosis or portal venous thrombosis (PVT), Child-Pugh (CPS) and MELD scores, bed days, rebleeding, reintervention, hepatic encephalopathy (HE), mortality, and TIPSS contraindication. <h3>Results</h3> Of 33 patients, 28 had cirrhotic portal hypertension (CPH) and 5 had non-cirrhotic portal hypertension (NCPH). The median age was 60.5 for CPH and 70 for NCPH. The cohort included 13 women (39%). The distribution of Child-Pugh scores was 15/33 CPS C, 14/33 CPS B, and 4/33 CPS A. The attached table contrasts demographics and outcomes by index IR procedure. 13/33 patients (39%) had an embolisation as the index procedure. In the 11 variceal embolisation patients, 7 rebled, and 6 underwent reintervention; 3 survived one year. Of the 2 splenic embolisation patients, one rebled but both survived at one year. 5 embolisation patients proceeded to TIPSS for reintervention, with no subsequent rebleed or reintervention. 3 survived one year. 20/33 patients (61%) had TIPSS as the index procedure. 6 rebled and required reintervention; 12 survived to one year. The most common complication post-TIPSS was new HE in 8 patients (40%). The median age of those who developed HE was 61, compared to 57.5 in those without HE. <h3>Discussion</h3> This review supports existing guidelines recommending TIPSS as the first-line IR intervention for endoscopically refractory AVB.^1–3 Although the sample size was small, the TIPSS cohort had fewer rebleeds, fewer reinterventions, and higher one-year survival compared to embolisation alone. Additionally, patients who initially underwent embolisation often subsequently required TIPSS to achieve definitive haemostasis. Non-cirrhotic portal hypertensive bleeding was less common than expected from departmental anecdotal discussions. In NCPH, splenic embolisation was effective in both cases reviewed, with both patients alive at one year. Post-TIPSS HE remains a particular concern in older patients. However, the over-65s in our cohort did surprisingly well, with all 5 alive at one year, and only one developing HE. This is presumably due to careful case selection. <h3>References</h3> Tripathi D, Stanley AJ, Hayes PC, <i>et al</i>. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. <i>Gut</i>. 2015;64:1680–1704. Tripathi D, Stanley AJ, Hayes PC, <i>et al</i>. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. <i>Gut</i>. 2020 Jul;69(7):1173–1192. doi: 10.1136/gutjnl-2019–320221. Epub 2020 Feb 29. European Association for the Study of the Liver. EASL clinical practice guidelines on TIPS. <i>J Hepatol</i>. 2025 Apr 1:S0168–8278(25)00066–2. doi: 10.1016/j.jhep.2025.01.029. Epub ahead of print.