HVPG-guided Laparoscopic Versus Endoscopic Therapy for Variceal Rebleeding in Portal Hypertension: A Multicenter Randomized Controlled Trial (CHESS1803)

Status: Unknown
Location: See all (4) locations...
Intervention Type: Procedure, Drug
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

The development of portal hypertension is a vital event in the natural progression of cirrhosis and is associated with severe complications including gastroesophageal varices bleeding. Cirrhotic patients with hemorrhagic shock and/or liver failure caused by variceal bleeding face a mortality of 5-20%. Hepatic venous pressure gradient (HVPG) is the recommended golden standard for portal pressure assessment globally with favorable consistency and repeatability. Reducing the HVPG to levels of 12mmHg or below is associated with protection of variceal hemorrhage. An HVPG\> 16mmHg indicates a higher risk of death and HVPG ≥ 20mmHg predicts failure to control bleeding, early rebleeding, and death during acute variceal hemorrhage. The management of portal hypertension has showed a trend of diversification with the development of medication, endoscopy, radiological intervention and liver transplantation. Although medication and endoscopic therapy have achieved preferable effects and are recommended as standard of care for the prevention of variceal rebleeding, patients with HVPG≥ 16mmHg still have a high risk of treatment failure and a high rate of rebleeding. Recent years, early TIPS is recommended as the first-line therapy for the prevention of rebleeding in cirrhotic patients with HVPG≥ 20mmHg. However, for those with HVPG values between 16 to 20mmHg, there is still lack of strong evidence to demonstrate the best practice for the management. With the rapid advancement of laparoscopic device and technique, the utility of laparoscopic splenectomy and pericardial devascularization showed less surgical trauma, bleeding and complications while retaining dependable effects compared to traditional open surgery, especially for portal hypertension with hypersplenism. In the study, the investigators aim to conduct a multicenter randomized controlled trial to compare the safety and effectiveness of HVPG-guided (16 to 20mmHg) laparoscopic versus endoscopic therapy for variceal rebleeding in patients with portal hypertension.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Maximum Age: 75
Healthy Volunteers: f
View:

• Clinically and/or pathologically diagnosed cirrhosis with portal hypertension

• History of varicial bleeding without receiving endoscopic treatment

• HVPG values between 16-20 mmHg

• ECOG score ≤ 2 or KPS score ≥ 60 during screening

• Voluntarily participated in the study and able to provide written informed consent, understand and willing to comply with the requirements of the study

• Child-Pugh class A or B

Locations
Other Locations
China
The Fifth Medical Center of Chinese PLA General Hospital
NOT_YET_RECRUITING
Beijing
The First Hospital of Lanzhou University
NOT_YET_RECRUITING
Lanzhou
Shunde Hospital, Southern Medical University
NOT_YET_RECRUITING
Shunde
Xingtai People's Hospital
RECRUITING
Xingtai
Contact Information
Primary
Xiaolong Qi, MD
qixiaolong@vip.163.com
86-18588602600
Time Frame
Start Date: 2019-01-02
Completion Date: 2022-10-28
Participants
Target number of participants: 40
Treatments
Experimental: Experimental group
Procedure: Laparoscopic splenectomy and pericardial devascularization Drug: Propranolol
Active_comparator: Control group
Procedure: Endoscopic therapy Drug: Propranolol
Sponsors
Collaborators: Southern Medical University, China, LanZhou University, Beijing 302 Hospital, Xingtai People's Hospital
Leads: Nanfang Hospital, Southern Medical University

This content was sourced from clinicaltrials.gov

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