S1018 Disparities and Outcomes in TIPS vs EBL Use for Esophageal Varices (2016-2022)

Introduction: Esophageal varices (EV) are a serious complication of portal hypertension. Endoscopic band ligation (EBL) and transjugular intrahepatic portosystemic shunt (TIPS) are key treatments, with evolving guidelines and patient profiles shaping their use and outcomes. This study compares demographics and in-hospital outcomes to understand current treatment use. Methods: EV patients who underwent TIPS and EBL between 2016-2022 were identified from the National Inpatient Sample (NIS) database using International Classification of Diseases-10 codes. Survey-weighted multivariate logistic regression identified independent predictors of each procedure. Separate adjusted models evaluated associations with in-hospital mortality, length of stay, and total hospital charges. Odd ratios (ORs) (95% confidence interval [CI]) were calculated for descriptive statistics. Results: The survey weighted number of patients with EV was 1.17 million between 2016-2022. Of these, 2.26% underwent TIPS and 19.64% received EBL. TIPS procedures were 17% less likely on weekends (OR 0.83; 95% CI 0.77-0.89). Female patients had 13% lower odds of receiving TIPS (OR 0.87; 95% CI 0.82-0.92) and 17% lower odds of receiving EBL (OR 0.83; 95% CI 0.81-0.85). White patients were most likely to receive TIPS, while Native Americans had the highest odds of EBL (OR 1.24; 95% CI 1.11-1.38). Black patients had the lowest odds for both procedures, with 50% lower odds for TIPS (OR 0.51; 95% CI 0.44-0.58) and 15% lower for EBL (OR 0.85; 95% CI 0.82-0.89). EBL was less common in highest-income areas (OR 0.864; 95% CI 0.833-0.895). Patients with self-pay had 73.9% higher odds of undergoing EBL (OR 1.739) compared to those with private insurance. Large bed-size hospitals (OR 3.26; 95% CI 2.91-3.66), urban non-teaching (OR 3.21; 95% CI 2.13-4.85) and urban teaching centers (OR 7.38; 95% CI 4.94-11.03) favored TIPS. TIPS had 86% higher mortality (OR 1.86), 2.5-day longer stays, and $106,954 higher charges. All results were statistically significant (P < 0.001). Conclusion: In conclusion, TIPS is used less often than EBL for EV, with disparities by gender, race, socioeconomic status, and hospital type. It was less likely on weekends, in women, and in Black patients, but more common in large, urban teaching hospitals. Self-pay patients had lower odds of TIPS and higher odds of EBL. Despite higher mortality, longer stays, and greater costs with TIPS, access remained uneven. These findings call for more equitable and standardized EV care.