Dig Dis 2005;23:56–64

Transjugular Intrahepatic Portosystemic Shunt

Ochs A.
Department of Internal Medicine, Evangelisches Diakonie Krankenhaus, Teaching Hospital of the Medical Faculty, University of Freiburg, Freiburg, Germany
email Corresponding Author

 goto top of outline Key Words

  • Portal hypertension
  • Variceal bleeding
  • Ascites
  • Hepatorenal syndrome
  • TIPS
  • Budd-Chiari syndrome
  • Hepatic hydrothorax
  • Endoscopic band ligation
  • Cirrhosis
  • Hepatic encephalopathy

 goto top of outline Abstract

The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side portosystemic anastomosis. Since its introduction 16 years ago, more than 1,000 publications have appeared demonstrating broad acceptance and increasing clinical use. This review summarizes our present knowledge about technical aspects and complications, follow-up of patients and indications. A technical success rate near 100% and a low occurrence of complications clearly depend on the skills of the operator. The follow-up of the TIPS patient has to assess shunt patency, liver function, hepatic encephalopathy and the possible development of hepatocellular carcinoma. Shunt patency can best be monitored by duplex sonography and can avoid routine radiological revision. Short-term patency may be improved by anticoagulation, while such a treatment does not influence long-term patency. Stent grafts covered with expanded polytetrafluoroethylene show promising long-term patency comparable with that of surgical shunts. With respect to the indications of TIPS, much is known about treatment of variceal bleeding and refractory ascites. The thirteen randomized studies that are available to date show that survival is comparable in patients receiving TIPS or endoscopic treatment for acute or recurrent variceal bleeding. Another group comprises patients with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrated that TIPS improves these complications. Five randomized studies comparing TIPS with paracentesis and one study comparing TIPS with the peritoneo-venous shunt showed good response of ascites but controversial results on survival. In addition, TIPS has been successfully applied to patients with Budd-Chiari syndrome, portal vein thrombosis, before liver transplantation, and for the treatment of ectopic variceal bleeding.

Copyright © 2005 S. Karger AG, Basel

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 goto top of outline Author Contacts

Prof. Andreas Ochs, MD, MBA
Head of the Department of Internal Medicine, Evangelisches Diakonie Krankenhaus
Teaching Hospital of the Medical Faculty University of Freiburg
Wirthstrasse 11, D–79110 Freiburg (Germany)
Tel. +49 761 1301233, Fax +49 761 1301633, E-Mail andi.ox@t-online.de

 goto top of outline Article Information

Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 3, Number of References : 124

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Digestive Diseases (State-of-the-Art Clinical Reviews)

Vol. 23, No. 1, Year 2005 (Cover Date: 2005)

Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257–2753 (print), 1421–9875 (Online)

For additional information: http://www.karger.com/ddi

Copyright / Drug Dosage / Disclaimer

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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