Self-expandable metal stent versus transjugular intrahepatic portosystemic shunt in refractory post-endoscopic variceal ligation ulcer bleeding: a retrospective cohort analysis of efficacy, safety, and quality-of-life outcomes from a tertiary care center in India.

BACKGROUND/AIMS: Post-endoscopic variceal ligation ulcer bleeding (PEBU) is a rare but life-threatening complication in cirrhosis, often refractory to standard therapy. While transjugular intrahepatic portosystemic shunt (TIPS) is effective, its complexity and risk of hepatic encephalopathy limit its use. Self-expandable metal stent (SEMS) offers a minimally invasive alternative, but comparative data are limited. This study evaluated SEMS versus TIPS in refractory PEBU. METHODS: In this retrospective cohort study, 30 cirrhotic patients with refractory PEBU at a tertiary Indian center were treated with either SEMS (n=15) or TIPS (n=15). The primary endpoint was hemostasis within 72 hours without rebleeding within 5 days. Secondary outcomes included 12-week rebleeding, mortality, complications, and quality of life (Patient-Reported Outcomes Measurement Information System [PROMIS]-10). RESULTS: Baseline characteristics were comparable. Immediate hemostasis was achieved in 100% (SEMS) and 93.3% (TIPS) (p=0.31). Rebleeding rates were similar (13.3%). SEMS showed lower mortality (6.7% vs. 20%) and less hepatic encephalopathy (20% vs. 46.7%). SEMS showed superior PROMIS-10 scores (13.93±4.33 vs.10.07±4.57, p<0.001) and shorter intensive care unit stay (2 vs. 5 days, p=0.002). Stent migration occurred in 20%. CONCLUSIONS: SEMS provides outcomes comparable to TIPS with fewer complications and easier applicability, supporting its use in resource-limited settings.