Transjugular Intrahepatic Portosystemic Shunt versus Percutaneous Transhepatic Variceal Embolization for Esophageal-Gastric Variceal Bleeding in Rural China: A Retrospective Cohort Study Focusing on Survival and Rebleeding

Background Esophageal-gastric variceal bleeding (EGVB) secondary to portal hypertension (PH) poses a greater therapeutic challenge in rural China. Patients often present with more severe conditions, including a high prevalence of portal vein thrombosis, tumor thrombi, and cavernous transformation of the portal vein (CTPV), making conventional treatments less effective. Methods This retrospective cohort study analyzed data from EGVB patients in rural Eastern China (Qingdao) who underwent interventional therapy between January 2021 and December 2024.Patients were divided into a Transjugular Intrahepatic Portosystemic Shunt (TIPS) group and a Percutaneous Transhepatic Gastric Variceal Embolization (PTVE) group. The primary outcomes were overall survival (OS), rebleeding intervals, and the incidence of hepatic encephalopathy (HE). Results The median OS was significantly longer in the TIPS group compared to the PTVE group (23.0 months vs. 4.5 months). The rebleeding interval was also significantly longer in the TIPS group. Hepatic encephalopathy occurred exclusively in the TIPS group, with a two-year cumulative incidence of 28.17%. The two-year stent dysfunction rate in the TIPS group was 8.5%. Conclusion For eligible EGVB patients in rural China, TIPS is significantly superior to PTVE in improving long-term survival and preventing rebleeding. Therefore, TIPS should be considered the preferred treatment strategy, although careful monitoring and management of hepatic encephalopathy are essential.