Document Detail


The use of TIPS in chronic liver disease.
MedLine Citation:
PMID:  16531959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The development of cirrhosis and portal hypertension in the natural history of chronic liver disease is associated with many complications. A transjugular intrahepatic portosystemic stent shunt (TIPS) is a metal prosthesis that has been shown to be very effective in lowering sinusoidal portal pressure, and therefore is effective in the management of complications of cirrhosis, especially those related to portal hypertensive bleeding and sodium and water retention. In patients with acute variceal bleeding not responding to pharmacologic and endoscopic treatments, a reduction of the hepatic venous pressure gradient to < 12 mmHg or by > 20% with TIPS has been shown to be effective in controlling the acute bleed and in preventing rebleeding. For stable patients whose acute variceal bleed is controlled, TIPS is equal to combined beta-blocker and band ligation in the prevention of recurrent variceal bleed. TIPS is also more effective than large volume paracentesis in the control of refractory ascites, and may confer a survival advantage over repeated large volume paracentesis. TIPS has also been used in the management of other complications related to portal hypertension including ectopic varices, hepatic hydrothorax, and hepatorenal syndrome with some success, but experience is still rather limited. Miscellaneous uses include treatment of Budd Chiari Syndrome, portal hypertensive gastropathy and hepatopulmonary syndrome. Careful patient selection is vital to a successful outcome, as patients with severe liver dysfunction tend to die post-TIPS despite a functioning shunt. All patients who require a TIPS for treatment of complications of cirrhosis should be referred for consideration of liver transplant.
Authors:
Florence Wong
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Annals of hepatology     Volume:  5     ISSN:  1665-2681     ISO Abbreviation:  Ann Hepatol     Publication Date:    2006 Jan-Mar
Date Detail:
Created Date:  2006-03-13     Completed Date:  2006-05-02     Revised Date:  2013-05-16    
Medline Journal Info:
Nlm Unique ID:  101155885     Medline TA:  Ann Hepatol     Country:  Mexico    
Other Details:
Languages:  eng     Pagination:  5-15     Citation Subset:  IM    
Affiliation:
Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. florence.wong@utoronto.ca
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MeSH Terms
Descriptor/Qualifier:
Chronic Disease
Female
Humans
Hypertension, Portal / diagnosis,  mortality,  surgery*
Liver Cirrhosis / diagnosis,  mortality,  surgery*
Liver Diseases / diagnosis,  mortality,  surgery
Male
Patient Selection
Portasystemic Shunt, Transjugular Intrahepatic / adverse effects,  methods*
Postoperative Complications / diagnosis,  mortality
Prognosis
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome

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


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