Gastrointest Interv.  2018 Oct;7(3):167-171. 10.18528/gii180026.

Transjugular intrahepatic portosystemic shunt creation for portal hypertension in patients with hepatocellular carcinoma: A systematic review

• Zhao H
• Tsauo J
• Zhang X
• Gong T
• Li J
• Li X

• KMID: 2435018
• DOI: http://doi.org/10.18528/gii180026

Abstract

BACKGROUND
To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for the management of portal hypertension in patients with hepatocellular carcinoma (HCC).
METHODS
A literature search of the MEDLINE/PubMed and Embase databases was conducted. All articles reporting the outcomes of TIPS creation for variceal bleeding and refractory ascites and hepatic hydrothorax in patients with HCC were included. Exclusion criteria were non-English language, sample size < 5, data not extractable, and data reported in another article.
RESULTS
A total of 280 patients (mean age, 48-58; male gender, 66%) from five articles were included. TIPS creation was performed for variceal bleeding in 79% and refractory ascites and/or hepatic hydrothorax in 26% of patients. Technical and clinical success was achieved in 99% and 64% of patients, respectively. Clinical failure occurred in 36% of patients due to rebleeding or recurrent bleeding (n = 77) or no resolution or improvement of refractory ascites and hepatic hydrothorax (n = 24). One percent of patient had major complications, including accelerated liver failure (n = 1) and multi-organ failure resulting from hemorrhagic shock (n = 1), all of which resulted in early (i.e., within 30 days) death. Hepatic encephalopathy occurred in 40% of patients after TIPS creation. Lung metastasis was found 1% of patient 5 months (n = 1) and 72 months (n = 1) after TIPS creation.
CONCLUSION
TIPS creation seems to be safe and effective for the management of portal hypertension in patients with HCC.

Keyword

Ascites; Gastrointestinal hemorrhage; Hydrothorax; Liver neoplasms; Portasystemic shunt, transjugular intrahepatic

MeSH Terms

Ascites
Carcinoma, Hepatocellular*
Esophageal and Gastric Varices
Gastrointestinal Hemorrhage
Hemorrhage
Hepatic Encephalopathy
Humans
Hydrothorax
Hypertension, Portal*
Liver Failure
Liver Neoplasms
Lung
Male
Neoplasm Metastasis
Portasystemic Shunt, Surgical*
Portasystemic Shunt, Transjugular Intrahepatic
Sample Size
Shock, Hemorrhagic