Keywords: TIPS, variceal embolization, portal hypertension

Background: A life threatening complication of portal hypertension is gastroesophageal variceal bleeding. Current standard of treatment in adults with variceal bleeding refractory to endoscopic intervention are transjugular intrahepatic portosystemic shunt (TIPS) or variceal embolization. However, there are no guidelines for when to perform these interventions in pediatric patients, which is largely accredited to limited research.

Objective: To investigate pediatric outcomes undergoing TIPS or variceal embolization for variceal bleeding secondary to portal hypertension, and to assess whether there is a difference in recurrence of variceal bleeding between the two interventions.

Methods: Between September 2012 and December 2023, 23 pediatric patients (<18 years old) underwent either TIPS or variceal embolization for gastroesophageal variceal bleeding refractory to endoscopic treatment. Baseline demographics were collected and outcome parameters were evaluated at 3 days, 1 month, 3 months, and 1 year. A Fisher test was performed to compare follow-up difference between the two treatment groups.

Results: Median patient age was 14 (range: 8 months – 17 years), 14 males and 9 females.

14 patients underwent TIPS, 9 underwent variceal embolization. Interventions were technically successful in 22/23 patients with 1 patient undergoing successful repeat TIPS 3 months later. One minor complication noted in TIPS and variceal embolization involving self-resolved extracapsular hematoma. No major complications.

Amongst the 22 treated patients, no patients bled at 3 day follow up, one bled at 1 month, none bled at 3 months, and three bled at 1 year.

There was no statistically significant difference (p > 0.05) in recurrence of bleeding between those that received TIPS versus variceal embolization.

Conclusions: TIPS and variceal embolization for variceal bleeding secondary to portal hypertension in pediatric patients demonstrated 1) improved variceal bleeding episodes and 2) no significant difference in recurrence of variceal bleeding between the two interventions at 3 days, 1 month, 3 months, and 1 year.