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Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic therapy and shunt surgery, and future prospectives.
World J Surg. 2001 Mar; 25(3):337-45; discussion 345-6.WJ

Abstract

During the 13 years since its introduction into clinical practice, transjugular intrahepatic portosystemic shunt (TIPS) has become widely accepted worldwide as a percutaneous, interventional procedure for treating complications of portal hypertension. An experienced, skillful team, however, is necessary to ensure the high technical success of TIPS and to avoid its potential procedural complications. Presently, TIPS is used mainly for treatment of acute or recurrent hemorrhage from gastroesophageal varices refractory to endoscopic therapy. Randomized studies have shown that it is more effective than endoscopic treatment for preventing rebleeding; however, it is associated with a higher incidence of encephalopathy. Both treatments produce comparable survival rates. TIPS is also effective in the treatment of hepatogenic ascites and hydrothorax and hepatorenal syndrome. In comparison with surgical shunts, TIPS is a significantly less invasive procedure that can be done in poor surgical candidates with advanced cirrhosis. The high rate of shunt obstructions seen with TIPS mandates close surveillance and maintenance, rendering TIPS a multistage procedure. This is a major disadvantage of TIPS compared to surgery. Presently, both TIPS and surgical shunts have their place in the treatment of gastroesophageal variceal hemorrhage unresponsive to endoscopic therapy. TIPS is most suited for class B and C patients, particularly those who are candidates for liver transplantation. Surgical shunts should be considered for patients with well preserved liver function. Large, randomized controlled studies should be done to compare these treatment methods. Animal experimental and early clinical studies using covered stents (stent-grafts) are promising for the prevention of shunt obstructions and thus converting TIPS from a multistage to a one-stage procedure.

Authors+Show Affiliations

Dotter Interventional Institute, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, L342, Portland, Oregon 97201-3098, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11343189

Citation

Rösch, J, and F S. Keller. "Transjugular Intrahepatic Portosystemic Shunt: Present Status, Comparison With Endoscopic Therapy and Shunt Surgery, and Future Prospectives." World Journal of Surgery, vol. 25, no. 3, 2001, pp. 337-45; discussion 345-6.
Rösch J, Keller FS. Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. World J Surg. 2001;25(3):337-45; discussion 345-6.
Rösch, J., & Keller, F. S. (2001). Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. World Journal of Surgery, 25(3), 337-45; discussion 345-6.
Rösch J, Keller FS. Transjugular Intrahepatic Portosystemic Shunt: Present Status, Comparison With Endoscopic Therapy and Shunt Surgery, and Future Prospectives. World J Surg. 2001;25(3):337-45; discussion 345-6. PubMed PMID: 11343189.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. AU - Rösch,J, AU - Keller,F S, Y1 - 2001/04/11/ PY - 2001/5/9/pubmed PY - 2001/7/13/medline PY - 2001/5/9/entrez SP - 337-45; discussion 345-6 JF - World journal of surgery JO - World J Surg VL - 25 IS - 3 N2 - During the 13 years since its introduction into clinical practice, transjugular intrahepatic portosystemic shunt (TIPS) has become widely accepted worldwide as a percutaneous, interventional procedure for treating complications of portal hypertension. An experienced, skillful team, however, is necessary to ensure the high technical success of TIPS and to avoid its potential procedural complications. Presently, TIPS is used mainly for treatment of acute or recurrent hemorrhage from gastroesophageal varices refractory to endoscopic therapy. Randomized studies have shown that it is more effective than endoscopic treatment for preventing rebleeding; however, it is associated with a higher incidence of encephalopathy. Both treatments produce comparable survival rates. TIPS is also effective in the treatment of hepatogenic ascites and hydrothorax and hepatorenal syndrome. In comparison with surgical shunts, TIPS is a significantly less invasive procedure that can be done in poor surgical candidates with advanced cirrhosis. The high rate of shunt obstructions seen with TIPS mandates close surveillance and maintenance, rendering TIPS a multistage procedure. This is a major disadvantage of TIPS compared to surgery. Presently, both TIPS and surgical shunts have their place in the treatment of gastroesophageal variceal hemorrhage unresponsive to endoscopic therapy. TIPS is most suited for class B and C patients, particularly those who are candidates for liver transplantation. Surgical shunts should be considered for patients with well preserved liver function. Large, randomized controlled studies should be done to compare these treatment methods. Animal experimental and early clinical studies using covered stents (stent-grafts) are promising for the prevention of shunt obstructions and thus converting TIPS from a multistage to a one-stage procedure. SN - 0364-2313 UR - https://www.unboundmedicine.com/medline/citation/11343189/Transjugular_intrahepatic_portosystemic_shunt:_present_status_comparison_with_endoscopic_therapy_and_shunt_surgery_and_future_prospectives_ L2 - https://dx.doi.org/10.1007/s002680020380 DB - PRIME DP - Unbound Medicine ER -