Dig Dis Interv 2017; 01(S 04): S1-S20
DOI: 10.1055/s-0038-1641650
Poster Presentations
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Early Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Cirrhosis and Variceal Bleeding

Min Lang
1  School of Medicine, Case Western Reserve University, Cleveland, Ohio
,
Karunakaravel Karuppasamy
2  Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Mark Sands
2  Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Maria del Pilar Bayona Molano
2  Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
William Carey
3  Internal Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
,
Baljendra S. Kapoor
2  Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
22 March 2018 (online)

 

Introduction and Content Organization Transjugular intrahepatic portosystemic shunt (TIPS) is traditionally used as a rescue treatment for recurrent uncontrolled acute variceal bleeding (AVB) in patients with cirrhosis. However, recent studies are challenging this view. Several groups have demonstrated that early TIPS (performed within 24–72 h of AVB) improves survival and reduces the rate of re-bleeding in high-risk patients compared with standard pharmacological and endoscopic therapies. Furthermore, the risk for hepatic encephalopathy, one of the most worrisome complications of TIPS, was not increased in patients who underwent early TIPS. In addition to better clinical outcomes, TIPS is also more cost effective than the current standard of care and may increase patients’ chance for liver transplantation. Patient selection for early TIPS is important, as the procedure is unlikely to benefit patients with severe end-stage liver disease and is not meant for those with mild hepatic dysfunction (Child–Pugh A). Finally, while the current results for early TIPS are promising, further prospective studies are needed to confirm these findings before early TIPS can be widely adopted.

Learning Points Studies have demonstrated that early TIPS for acute variceal bleeding in patients with cirrhosis is associated with:

  1. Lower rates of re-bleeding

  2. Improved survival

  3. Reduced hospitalization cost

  4. Increased likelihood for liver transplantation

  5. No increased risk of hepatic encephalopathy compared with medical + endoscopic management