Document Detail

Transjugular intrahepatic portosystemic shunt: current status.
MedLine Citation:
PMID:  12761727     Owner:  NLM     Status:  MEDLINE    
The transjugular intrahepatic portosystemic shunt (TIPS) was developed in the 1980s for treatment of complications of portal hypertension. Once it was shown that the shunt could be placed with relative ease, TIPS was rapidly applied to the treatment of many of the complications of portal hypertension. These complications include actively bleeding gastroesophageal varices, prevention of rebleeding from varices, control of refractory cirrhotic ascites and hepatic hydrothorax, and treatment of hepatorenal failure and hepatopulmonary syndrome. TIPS has also been used as therapy for Budd-Chiari syndrome and veno-occlusive disease. Despite these broad applications, TIPS has been compared with other forms of therapy in only 2 situations: prevention of rebleeding from varices and control of refractory cirrhotic ascites. In the trials, TIPS was shown to provide better control of these 2 complications of portal hypertension than standard forms of therapy. However, there was no improvement in survival and the incidence of encephalopathy was greater for patients receiving a TIPS. Thus, the use of TIPS for the control of ascites and prevention of rebleeding from varices should be limited to a select group of patients. There have been no controlled trials for the other indications listed. Despite the apparent efficacy of TIPS in many of these situations, its use should be limited to salvage therapy pending the publication of controlled trials showing it is a better treatment than other forms of therapy.
Thomas D Boyer
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Gastroenterology     Volume:  124     ISSN:  0016-5085     ISO Abbreviation:  Gastroenterology     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-22     Completed Date:  2003-06-25     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1700-10     Citation Subset:  AIM; IM    
Department of Medicine, University of Arizona College of Medicine, Tucson, 85724, USA.
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MeSH Terms
Ascites / etiology,  therapy
Equipment Failure
Esophageal and Gastric Varices / complications
Gastrointestinal Hemorrhage / etiology,  therapy
Hepatorenal Syndrome / therapy
Hydrothorax / etiology,  therapy
Hypertension, Portal / complications,  therapy
Liver Cirrhosis / complications
Liver Diseases / complications
Portasystemic Shunt, Transjugular Intrahepatic / adverse effects*,  instrumentation,  methods*,  mortality
Recurrence / prevention & control
Stomach Diseases / etiology,  therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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