Where does TIPS fit in the management of patients with cirrhosis?

JHEP Reports : Innovation in Hepatology
Juan Carlos García-PagánGuadalupe Garcia-Tsao

Abstract

In this review, we summarise the current knowledge on the indications and contraindications of transjugular intrahepatic portosystemic shunt (TIPS) placement for the treatment of the complications of portal hypertension in cirrhosis, specifically variceal haemorrhage and ascites. Moreover, we discuss the role of TIPS for the treatment of portal vein thrombosis (PVT) and the prevention of complications after extrahepatic surgery ('preoperative TIPS') in patients with cirrhosis. The position of TIPS in the treatment hierarchy depends on the clinical setting and on patient characteristics. In acute variceal haemorrhage, preemptive TIPS is indicated in patients at a high risk of failing standard therapy, that is those with a Child-Pugh score of 10-13 points or Child-Pugh B with active bleeding at endoscopy, although the survival benefit in the latter group still remains to be established. Non-preemptive TIPS is a second-line therapy for the prevention of recurrent variceal haemorrhage and for the treatment of ascites. Of note, TIPS may also improve sarcopenia. Contraindications to TIPS placement, independent of clinical setting, include very advanced disease (Child-Pugh >13 points), episodes of recurrent overt hepatic encephalopath...Continue Reading

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Citations

Mar 26, 2021·PLoS Neglected Tropical Diseases·Francesca TamarozziFederico G Gobbi
Apr 12, 2021·Clinics in Liver Disease·Mattias Mandorfer, Benedikt Simbrunner
Jul 14, 2021·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Mathias JachsMattias Mandorfer
Aug 10, 2021·World Journal of Hepatology·Nikolaus PfistererThomas Reiberger
Jul 30, 2021·Journal of Digestive Diseases·Sern Wei Yeoh, Hong Kuan Kok
Sep 8, 2021·Frontiers in Physiology·Johannes ChangMichael Praktiknjo

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