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The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension.
J Clin Gastroenterol. 2007 Nov-Dec; 41 Suppl 3:S344-51.JC

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiology technique that has shown a 90% success rate to decompress the portal circulation. As a non-surgical intervention, without requirement for anesthesia and very low procedure-related mortality, TIPS is applicable to severe cirrhotic patients, who are otherwise untreatable, for example, nonsurgical candidates. TIPS constitutes the most frequently employed tool to achieve portosystemic shunting. TIPS acts by lowering portal pressure, which is the main underlying pathophysiologic determinant of the major complications of cirrhosis. Regarding esophagogastric variceal bleeding, TIPS has excellent hemostatic effect (95%) with low rebleeding rate (<20%). TIPS is an accepted rescue therapy for first line treatment failures in 2 settings (1) acute variceal bleeding and (2) secondary prophylaxis. In addition, TIPS offers 70% to 90% hemostasis to patients presenting with recurrent active variceal bleeding. TIPS is more effective than standard therapy for patients with hepatic venous pressure gradient >20mm Hg. TIPS is particularly useful to treat bleeding from varices inaccessible to endoscopy. TIPS should not be applied for primary prophylaxis of variceal bleeding. Portosystemic encephalopathy and stent dysfunction are TIPS major drawbacks. The weakness of the TIPS procedure is the frequent need for endovascular reintervention to ensure stent patency. The circulatory effects of TIPS are an attractive approach for the treatment of refractory ascites and hepatorenal syndrome, yet TIPS is not considered first line therapy for refractory ascites owing to unacceptable incidence of portosystemic encephalopathy. Pre-TIPS evaluation taking into account predictors of outcome is mandatory. The improved results achieved with covered-stents might expand the currently accepted recommendations for TIPS use.

Authors+Show Affiliations

Hepatic Hemodynamic Section, Liver Unit, Gastroenterology Department, Buenos Aires British Hospital, Buenos Aires School of Medicine, Buenos Aires University, Buenos Aires, Argentina.

Pub Type(s)

Historical Article
Journal Article
Review

Language

eng

PubMed ID

17975487

Citation

Colombato, Luis. "The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension." Journal of Clinical Gastroenterology, vol. 41 Suppl 3, 2007, pp. S344-51.
Colombato L. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. J Clin Gastroenterol. 2007;41 Suppl 3:S344-51.
Colombato, L. (2007). The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. Journal of Clinical Gastroenterology, 41 Suppl 3, S344-51.
Colombato L. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension. J Clin Gastroenterol. 2007 Nov-Dec;41 Suppl 3:S344-51. PubMed PMID: 17975487.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. A1 - Colombato,Luis, PY - 2007/12/6/pubmed PY - 2008/2/7/medline PY - 2007/12/6/entrez SP - S344 EP - 51 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 41 Suppl 3 N2 - Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiology technique that has shown a 90% success rate to decompress the portal circulation. As a non-surgical intervention, without requirement for anesthesia and very low procedure-related mortality, TIPS is applicable to severe cirrhotic patients, who are otherwise untreatable, for example, nonsurgical candidates. TIPS constitutes the most frequently employed tool to achieve portosystemic shunting. TIPS acts by lowering portal pressure, which is the main underlying pathophysiologic determinant of the major complications of cirrhosis. Regarding esophagogastric variceal bleeding, TIPS has excellent hemostatic effect (95%) with low rebleeding rate (<20%). TIPS is an accepted rescue therapy for first line treatment failures in 2 settings (1) acute variceal bleeding and (2) secondary prophylaxis. In addition, TIPS offers 70% to 90% hemostasis to patients presenting with recurrent active variceal bleeding. TIPS is more effective than standard therapy for patients with hepatic venous pressure gradient >20mm Hg. TIPS is particularly useful to treat bleeding from varices inaccessible to endoscopy. TIPS should not be applied for primary prophylaxis of variceal bleeding. Portosystemic encephalopathy and stent dysfunction are TIPS major drawbacks. The weakness of the TIPS procedure is the frequent need for endovascular reintervention to ensure stent patency. The circulatory effects of TIPS are an attractive approach for the treatment of refractory ascites and hepatorenal syndrome, yet TIPS is not considered first line therapy for refractory ascites owing to unacceptable incidence of portosystemic encephalopathy. Pre-TIPS evaluation taking into account predictors of outcome is mandatory. The improved results achieved with covered-stents might expand the currently accepted recommendations for TIPS use. SN - 0192-0790 UR - https://www.unboundmedicine.com/medline/citation/17975487/The_role_of_transjugular_intrahepatic_portosystemic_shunt__TIPS__in_the_management_of_portal_hypertension_ L2 - https://doi.org/10.1097/MCG.0b013e318157e500 DB - PRIME DP - Unbound Medicine ER -