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Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications.
World J Gastroenterol. 2014 Dec 07; 20(45):16996-7010.WJ

Abstract

Portal hypertension (PH) plays an important role in the natural history of cirrhosis, and is associated with several clinical consequences. The introduction of transjugular intrahepatic portosystemic shunts (TIPS) in the 1980s has been regarded as a major technical advance in the management of the PH-related complications. At present, polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents. TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment. Recently, applying TIPS early (within 72 h after admission) has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding. In addition, TIPS is recommended as the second-line treatment for secondary prophylaxis. For bleeding gastric varices, applying TIPS was able to achieve hemostasis in more than 90% of patients. More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities, including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices. TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy. In patients with refractory ascites, there is growing evidence that TIPS not only results in better control of ascites, but also improves long-term survival in appropriately selected candidates. In addition, TIPS is a promising treatment for refractory hepatic hydrothorax. However, the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined. The advantage of TIPS is offset by a risk of developing hepatic encephalopathy, the most relevant post-procedural complication. Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome. This review is aimed at summarizing the published data regarding the application of TIPS in the management of complications related to PH.

Authors+Show Affiliations

Sith Siramolpiwat, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25493012

Citation

Siramolpiwat, Sith. "Transjugular Intrahepatic Portosystemic Shunts and Portal Hypertension-related Complications." World Journal of Gastroenterology, vol. 20, no. 45, 2014, pp. 16996-7010.
Siramolpiwat S. Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications. World J Gastroenterol. 2014;20(45):16996-7010.
Siramolpiwat, S. (2014). Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications. World Journal of Gastroenterology, 20(45), 16996-7010. https://doi.org/10.3748/wjg.v20.i45.16996
Siramolpiwat S. Transjugular Intrahepatic Portosystemic Shunts and Portal Hypertension-related Complications. World J Gastroenterol. 2014 Dec 7;20(45):16996-7010. PubMed PMID: 25493012.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications. A1 - Siramolpiwat,Sith, PY - 2014/06/05/received PY - 2014/07/09/revised PY - 2014/08/13/accepted PY - 2014/12/11/entrez PY - 2014/12/11/pubmed PY - 2015/9/4/medline KW - Ascites KW - Cirrhosis KW - Portal hypertension KW - Transjugular intrahepatic portosystemic shunts KW - Varices SP - 16996 EP - 7010 JF - World journal of gastroenterology JO - World J Gastroenterol VL - 20 IS - 45 N2 - Portal hypertension (PH) plays an important role in the natural history of cirrhosis, and is associated with several clinical consequences. The introduction of transjugular intrahepatic portosystemic shunts (TIPS) in the 1980s has been regarded as a major technical advance in the management of the PH-related complications. At present, polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents. TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment. Recently, applying TIPS early (within 72 h after admission) has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding. In addition, TIPS is recommended as the second-line treatment for secondary prophylaxis. For bleeding gastric varices, applying TIPS was able to achieve hemostasis in more than 90% of patients. More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities, including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices. TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy. In patients with refractory ascites, there is growing evidence that TIPS not only results in better control of ascites, but also improves long-term survival in appropriately selected candidates. In addition, TIPS is a promising treatment for refractory hepatic hydrothorax. However, the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined. The advantage of TIPS is offset by a risk of developing hepatic encephalopathy, the most relevant post-procedural complication. Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome. This review is aimed at summarizing the published data regarding the application of TIPS in the management of complications related to PH. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25493012/Transjugular_intrahepatic_portosystemic_shunts_and_portal_hypertension_related_complications_ DB - PRIME DP - Unbound Medicine ER -