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Patient Selection for Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion in Variceal Bleeding and Refractory Ascites

  • Portal Hypertension (J Abraldes and E Tsochatzis, Section Editors)
  • Published:
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Abstract

Purpose of the Review

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is used to treat the complications of portal hypertension. Patient selection prior to TIPSS remains paramount for survival. This review aims to summarise the key clinical steps in patient selection prior to TIPSS and how patient selection has evolved over the last 5 years.

Recent Findings

Model for End-Stage Liver Disease (MELD) and Child-Pugh scoring in combination remain good predictors of clinical outcome post TIPSS. Minimal hepatic encephalopathy remains a diagnostic challenge, and further testing should be implemented in elective assessment. Portal vein thrombosis is no longer an absolute contraindication. The importance of diastolic dysfunction pre TIPSS remains controversial, and at present echocardiography is only recommended in patients with preexisting cardiac disease, cardiac symptoms and/or incidental abnormal ECG.

Summary

A combination of MELD, Child-Pugh, age, encephalopathy and liver imaging remain key in assessing risk pre TIPSS. A multidisciplinary team approach should be adopted for patient selection.

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Authors and Affiliations

  1. Liver Unit, Queen Elizabeth Hospital, Birmingham, UK

    A. Dhaliwal, M. J. Armstrong & D. Tripathi

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  1. A. Dhaliwal
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Correspondence to D. Tripathi.

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A. Dhaliwal and M.J. Armstrong each declare no potential conflict of interest.

D. Tripathi reports personal fees from Gore Medical during the conduct of the study and personal fees from Norgine outside the submitted work.

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This article contains no studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Portal Hypertension

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Dhaliwal, A., Armstrong, M.J. & Tripathi, D. Patient Selection for Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion in Variceal Bleeding and Refractory Ascites. Curr Hepatology Rep 16, 241–249 (2017). https://doi.org/10.1007/s11901-017-0361-y

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