Korean J Intern Med.  2000 Dec;15(3):179-186.

Clinical Results of the Transjugular Intrahepatic Portosystemic Shunt (TIPS) for the Treatment of Variceal Bleeding

• Han SW
• Joo YE
• Kim HS
• Choi SK
• Rew JS
• Kim JK
• Kim SJ

Abstract

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) has been popularized for the treatment of refractory variceal bleeding. The aim of this study was to assess the safety and long-term effect of TIPS in the treatment of variceal bleeding that is not controlled with pharmacological and endoscopic treatment.
METHODS
Thirty-six patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) due to refractory variceal bleeding were included in the study. The effectiveness of portal decompression and bleeding control was evaluated. Upper gastrointestinal endoscopy was performed to analyse the degree of varices and portal hypertensive gastropathy (PHG) before TIPS procedure and one to three weeks after TIPS. Angiography was performed in surviving patients, if bleeding recurred, or if ultrasonography or endoscopy suggested stent dysfunction.
RESULTS
TIPS were successfully placed in 36 of 38 patients (94.6%). TIPS achieved hemostasis of variceal bleeding in 34 patients (94.4%). Portal venous pressure decreased from an initial average of 28.7 +/- 7.9 to 23.2 +/- 9.4 mmHg after TIPS (p < 0.05). The portosystemic pressure gradient was significantly decreased from 15.5 +/- 6.3 to 7.8 +/- 4.1 mmHg (p < 0.01). The degree of esophagogastric varices and PHG was significantly improved after TIPS. The total length of follow-up was from one day to 54 months (mean: 355 days). The actuarial probability of survival was 83% at one year and 74% at two years. Overall, 16 episodes of stent dysfunction were diagnosed during follow-up. Stent revision by means of angioplasty was successfully performed in 14 of these episodes.
CONCLUSION
TIPS is an effective and reliable nonoperative means of lowering portal pressure. This procedure has proved useful in the management of acute variceal bleeding refractory to endoscopic treatment. Surveillance by ultrasonography, endoscopy, and angiographic intervention is useful for the maintenance of shunt patency.

Keyword

Hypertension; Portal, Esophageal and Gastric varices; TIPS (transjugular intrahepatic portosystemic shunt)

MeSH Terms

Adult
Aged
Esophageal and Gastric Varices/surgery*
Esophageal and Gastric Varices/complications
Female
Gastrointestinal Hemorrhage/surgery*
Gastrointestinal Hemorrhage/etiology
Human
Hypertension, Portal/surgery
Hypertension, Portal/complications
Male
Middle Age
Portasystemic Shunt, Transjugular Intrahepatic*/mortality
Portasystemic Shunt, Transjugular Intrahepatic*/adverse effects
Recurrence
Survival Rate