Treatment of peristomal hemorrhage: A review of outcomes and comparison of two minimally invasive techniques

Purpose: The purpose of this study was to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments in patients with peristomal variceal bleeding. Materials and methods: Ten patients who underwent sclerotherapy (n = 3 patients), TIPS placement (n = 5 patients) or both (n= 2 patients) for peristomal variceal bleeding were retrospectively reviewed. There were 6 women and 4 men, with a mean age of 62.6 years (range: 44–84 years). Data pertaining to the technical aspects of the procedure, demographics, and information regarding the underlying cause of ostomy and portal hypertension were collected. Treatment was considered a primary success if no further hemorrhage occurred. Results: No differences in primary success were found between TIPS cohort (100%) and sclerotherapy cohort (40%) (P = 0.4). Sclerotherapy patients had a poorer nutritional status (mean albumin serum level of 2.04 g/dL in the sclerotherapy group and 2.95 g/dL in theTIPS group; P = 0.04) and worse liver function (mean total bilirubin serum level of 4.9 mg/dL in the sclerotherapy group and 1.6 mg/dL in the TIPS group; P = 0.07). Conclusion: While further investigation is needed, TIPS may be more effective than sclerotherapy in treating peristomal variceal bleeding. However, sclerotherapy may serve as an effective bridging mechanism in critically ill patients.