Transjugular intrahepatic portosystemic shunt (TIPS) for cirrhosis

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that may be used to reduce portal hypertension and its complications, especially variceal bleeding. A TIPS procedure may be performed by a radiologist, who places a small wire-mesh coil (stent) into a liver vein. The stent is then expanded using a small inflatable balloon (angioplasty). The stent forms a channel, or shunt, that bypasses the liver. This channel reduces pressure in the portal vein. By reducing portal hypertension, enlarged veins (varices) are less likely to rupture and bleed, and other complications of cirrhosis called ascites (fluid in the abdomen) and hepatic hydrothorax (fluid between the lungs and the chest wall) may improve or go away.

TIPS may be used to:

• Treat fluid buildup that continues to occur in the abdominal cavity despite medical therapy (refractory ascites).
• Treat acute variceal bleeding that is not controlled by standard treatment.
• Prevent recurrent episodes of variceal bleeding when sclerotherapy or band ligation has failed.
• Treat variceal bleeding while someone is waiting for a liver transplant.

TIPS may be more effective than sclerotherapy at reducing the risk of rebleeding from esophageal varices:¹

• In people treated with TIPS, 24% had rebleeding 17 months after treatment.
• In people treated with sclerotherapy, 51% had rebleeding 18 months after treatment.

Although TIPS may be more effective than sclerotherapy at decreasing bleeding from varices, TIPS may not prolong life more than sclerotherapy.¹ Also, TIPS can have complications that may outweigh its benefits. Complications of the procedure may include:

• Encephalopathy. Up to 30% of people who have TIPS surgery develop encephalopathy after the surgery.²
• Malfunction of the stent, such as narrowing (stenosis) or closing (occlusion). One study showed that 1 year after the placement of a stent during TIPS, 61% of the stents malfunctioned.¹

Because the long-term effects of TIPS are unknown and complications are associated with the procedure, TIPS may not be the best way to treat variceal bleeding.

Citations

1. Merli M, et al. (1998). Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal bleeding in cirrhosis: A randomized multicenter trial. Hepatology, 27(1): 48–53.

2. Shah VH, Kamath PS (2006). Portal hypertension and gastrointestinal bleeding. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1899–1934. Philadelphia: W.B. Saunders.