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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 7
Jul.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(7): 1513-1522

Clinical application of early transjugular intrahepatic portosystemic shunt and related and research advances

DOI: 10.3969/j.issn.1001-5256.2023.07.001

  • Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China

Research funding:

The Social Development General Program of Jiangsu Province (BE20221648);

The People's livelihood Technology Program of Suzhou (SS202059)

More Information
  • Corresponding author: ZHU Xiaoli, zhuxiaoli90@163.com (ORCID: 0000-0002-3507-2018)
  • Received Date: 2022-05-16
  • Accepted Date: 2023-06-21
  • Published Date: 2023-07-20
    Abstract
  • Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to establish a portosystemic shunt between the hepatic vein and the portal vein via the jugular approach, so as to reduce portal venous pressure and control acute esophagogastric variceal bleeding (EGVB). The prognosis of EGVB has been improved significantly over the past few decades, and endoscopic variceal ligation combined with drug therapy is now recommended as the first-line treatment regimen for this disease. The latest research advances in the management of EGVB over the past decade have focused on the relatively new concept of "early" or "pre-emptive" TIPS, that is to say, early TIPS (within 72 hours after admission, ideally within 24 hours) is recommended for patients with EGVB who are at a relatively high risk of failure in standard treatment. This article briefly introduces the effect of early TIPS on controlling bleeding, mortality rate, and hepatic encephalopathy, the high-risk population for early TIPS, timing of intervention, cost effectiveness, the applications of early TIPS in a real-world setting, and recommendations for early TIPS in international guidelines and consensus statements.

     

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  • [1]
    BOSCH J, ABRALDES JG, ALBILLOS A, et al. Portal hypertension: recommendations for evaluation and treatment: consensus document sponsored by the Spanish Association for the Study of the Liver (AEEH) and the Biomedical Research Network Center for Liver and Digestive Diseases(CIBERehd)[J]. Gastroenterol Hepatol, 2012, 35(6): 421-450. DOI: 10.1016/j.gastrohep.2012.02.009.
    [2]
    REVERTER E, TANDON P, AUGUSTIN S, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding[J]. Gastroenterology, 2014, 146(2): 412-419. e3. DOI: 10.1053/j.gastro.2013.10.018.
    [3]
    de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno VⅡ - Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
    [4]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024.
    [5]
    GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906.
    [6]
    ROSCH J, HANAFEE WN, SNOW H. Transjugular portal venography and radiologic portac- aval shunt: an experimental study[J]. Radiology, 1969, 92(5): 1112-1114. DOI:10.1148/92.5. 1112.
    [7]
    ROSCH J, HANAFEE W, SNOW H, et al. Transjugular intrahepatic portacaval shunt. An exp erimental work[J]. Am J Surg, 1971, 121(5): 588-592. DOI: 10.1016/0002-9610(71)90147-4.
    [8]
    RICHTER GM, NOELDGE G, PALMAZ JC, et al. The transjugular intrahepatic portosystemic stent-shunt (TIPSS): results of a pilot study[J]. Cardiovasc Intervent Radiol, 1990, 13(3): 200-207. DOI: 10.1007/BF02575474.
    [9]
    SAAD WE. The history and future of transjugular intrahepatic portosystemic shunt: food for thought[J]. Semin Intervent Radiol, 2014, 31(3): 258-261. DOI: 10.1055/s-0034-1382794.
    [10]
    TRIPATHI D, STANLEY AJ, HAYES PC, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut, 2015, 64(11): 1680-1704. DOI: 10.1136/gut-jnl-2015-309262.
    [11]
    MONESCILLO A, MARTíNEZ-LAGARES F, RUIZ-DEL-ARBOL L, et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding[J]. Hepatology, 2004, 40(4): 793-801. DOI: 10.1002/hep.20386.
    [12]
    GARCIA-PAGAN JC, CACA K, BUREAU C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med, 2010, 362(25): 2370-2379. DOI: 10.1056/NEJMoa-0910102.
    [13]
    LV Y, YANG Z, LIU L, et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2019, 4(8): 587-598. DOI: 10.1016/S2468-1253(19)30090-1.
    [14]
    JAIRATH V, REHAL S, LOGAN R, et al. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit[J]. Dig Liver Dis, 2014, 46(5): 419-426. DOI: 10.1016/j.dld.2013.12.010.
    [15]
    GARCIA-TSAO G, BOSCH J. Management of varices and variceal hemorrhage in cirrhosis[J]. N Engl J Med, 2010, 362(9): 823-832. DOI: 10.1056/NEJMra0901512.
    [16]
    Italian Association for the Study of the Liver (AISF). Portal hypertension and ascites: patient-and population-centered clinical practice guidelines by the Italian Association for the Study of the Liver (AISF)[J]. Dig Liver Dis, 2021, 53(9): 1089-1104. DOI: 10.1016/j.dld.2021.06.021.
    [17]
    AZOULAY D, CASTAING D, MAJNO P, et al. Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis[J]. J Hepatol, 2001, 35(5): 590-597. DOI: 10.1016/s0168-8278(01)00185-4.
    [18]
    BANARES R, CASADO M, RODRIGUEZ-LAIZ JM, et al. Urgent transjugular intrahepatic por- tosystemic shunt for control of acute variceal bleeding[J]. Am J Gastroenterol, 1998, 93(1): 75-79. DOI: 10.1046/j.1365-2125.1998.t01-1-00689.x.
    [19]
    ESCORSELL A, BAÑARESÍ R, GARCÍA-PAGÁN JC, et al. TIPS versus drug therapy in preventing variceal rebleeding in advanced cirrhosis: a randomized controlled trial[J]. Hepatology, 2002, 35(2): 385-392. DOI: 10.1053/jhep.2002.30418.
    [20]
    BOSCH J. Salvage transjugular intrahepatic portosystemic shunt: is it really life-saving?[J]. J Hepatol, 2001, 35(5): 658-660. DOI: 10.1016/s0168-8278(01)00238-0.
    [21]
    D'AMICO G, PAGLIARO L, BOSCH J. The treatment of portal hypertension: a meta-analytic review[J]. Hepatology, 1995, 22(1): 332-354. DOI: 10.1002/hep.1840220145.
    [22]
    MERLI M, NICOLINI G, ANGELONI S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients[J]. J Hepatol, 2003, 38(3): 266-272. DOI: 10.1016/s0168-8278(02)00420-8.
    [23]
    D'AMICO G, MORABITO A, D'AMICO M, et al. Clinical states of cirrhosis and competing risks[J]. J Hepatol, 2018, 68(3): 563-576. DOI: 10.1016/j.jhep.2017.10.020.
    [24]
    LAINE L, COOK D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis[J]. Ann Intern Med, 1995, 123(4): 280-287. DOI: 10.7326/0003-4819-123-4-199508150-00007.
    [25]
    THABUT D, PAUWELS A, CARBONELL N, et al. Cirrhotic patients with portal hypertension-related bleeding and an indication for early-TIPS: a large multicentre audit with real-life results[J]. J Hepatol, 2017, 68(1): 73-81. DOI: 10.1016/j.jhep.2017.09.002.
    [26]
    NJEI B, MCCARTY TR, LAINE L. Early transjugular intrahepatic portosystemic shunt in US patients hospitalized with acute esophageal variceal bleeding[J]. J Gastroenterol Hepatol, 2017, 32(4): 852-858. DOI: 10.1111/jgh.13593.
    [27]
    SHADI AL H, TAREK S, BESHER S, et al. Early TIPS versus endoscopic therapy for secondary prophylaxis after management of acute esophageal variceal bleeding in cirrhotic patients: a meta-analysis of randomized controlled trials[J]. J Gastroenterol Hepatol, 2016, 31(9): 1519-1526. DOI: 10.1111/jgh.13303.
    [28]
    The Chinese College of Interventionalists. CCI clinical practice guidelines: Management of TIPS for portal hypertension (2019 edition)[J]. J Clin Hepatol, 2019, 35(12): 2694-2699. DOI: 10.3969/j.issn.1001-5256.2019.12.010.

    中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2694-2699. DOI: 10.3969/j.issn.1001-5256.2019.12.010.
    [29]
    BAIGES A, MAGAZ M, TURON F, et al. Treatment of acute variceal bleeding in 2021-when to use transjugular intrahepatic portosystemic shunts?[J]. Clin Liver Dis, 2021, 25(2): 345-356. DOI: 10.1016/j.cld.2021.01.001.
    [30]
    CONEJO I, GUARDASCIONE MA, TANDON P, et al. Multicenter external validation of risk stratification criteria for patients with variceal bleeding[J]. Clin Gastroenterol Hepatol, 2018, 16(1): 132-139. e8. DOI: 10.1016/j.cgh.2017.04.042.
    [31]
    LV Y, ZUO L, ZHU X, et al. Identifying optimal candidates for early TIPS among patients with cirrhosis and acute variceal bleeding: a multicentre observational study[J]. Gut, 2019, 68(7): 1297-1310. DOI: 10.1136/gutjnl-2018-317057.
    [32]
    HWANG GL, SZE DY. Survival in cirrhotic patients with high MELD Scores: the TIPping point[J]. Dig Dis Sci, 2017, 62(2): 296-298. DOI: 10.1007/s10620-016-4376-y.
    [33]
    HERNÁNDEZ-GEA V, PROCOPET B, GIRÁLDEZ Á, et al. Preemptive-TIPS improves outcome in high-risk variceal bleeding: an observational study[J]. Hepatology, 2019, 69(1): 282-293. DOI: 10.1002/hep.30182.
    [34]
    MANNING C, ELZUBEIR A, ALAM S. The role of pre-emptive transjugular intrahepatic portosystemic shunt in acute variceal bleeding: a literature review[J]. Ther Adv Chronic Dis, 2021, 12: 2040622321995771. DOI: 10.1177/2040622321995771.
    [35]
    Korean Association for the Study of the Liver. KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications[J]. Clin Mol Hepatol, 2020, 26(2): 83-127. DOI: 10.3350/cmh.2019.0010n.
    [36]
    RUDLER M, CLUZEL P, CORVEC TL, et al. Early-TIPSS placement prevents rebleeding in high-risk patients with variceal bleeding, without improving survival[J]. Aliment Pharmacol Ther, 2014, 40(9): 1074-1080. DOI: 10.1111/apt.12934.
    [37]
    GARCIA-PAGÁN JC, DI PASCOLI M, CACA K, et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study[J]. J Hepatol, 2013, 58(1): 45-50. DOI: 10.1016/j.jhep.2012.08.020.
    [38]
    ZHOU GP, JIANG YZ, SUN LY, et al. Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis[J]. Eur Radiol, 2021, 31(7): 5390-5399. DOI: 10.1007/s00330-020-07525-x.
    [39]
    NICOARA-FARCAU O, HAN G, RUDLER M, et al. Effects of early placement of transjugular portosystemic shunts in patients with high-risk acute variceal bleeding: a Meta analysis of individual patient data[J]. Gastroenterology, 2021, 160(1): 193-205. e10. DOI: 10.1053/j.gastro.2020.09.026
    [40]
    TRIPATHI D, STANLEY AJ, HAYES PC, et al. Transjugular intrahepatic portosystemic stent shunt in the management of portal hypertension[J]. Gut, 2020, 69(7): 1173-1192. DOI: 10.1136/gutjnl-2019-320221.
    [41]
    DELTENRE P, TREPO E, RUDLER M, et al. Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta analysis of controlled trials[J]. Eur J Gastroenterol Hepatol, 2015, 27(9): e1-e9. DOI: 10.1097/MEG.0000000000000403.
    [42]
    GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906.
    [43]
    TRIPATHI D, STANLEY AJ, HAYES PC, et al. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension[J]. Gut, 2020, 69(7): 1173-1192. DOI: 10.1136/gutjnl-2019-320221.
    [44]
    de FRANCHIS R, PRIMIGNANI M. Why do varices bleed?[J]. Gastroenterol Clin North Am, 1992, 21(1): 85-101.
    [45]
    GARCÍA-PAGÁN JC, CACA K, BUREAU C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med, 2010, 362(25): 2370-2379. DOI: 10.1056/NEJMoa0910102.
    [46]
    THABUT D, PAUWELS A, CARBONELL N, et al. Cirrhotic patients with portal hypertension-related bleeding and an indication for early-TIPS: a large multicentre audit with real-life results[J]. J Hepatol, 2017, 68(1): 73-81. DOI: 10.1016/j.jhep.2017.09.002.
    [47]
    DUNNE P, FINKEL J, KHAN F, et al. Effect of time to pre- emptive transjugular intrahepatic portosystemic shunt on patient outcome, a UK multi- centre cohort study[J]. Aliment Pharmacol Ther, 2023, 57(2): 237-244. DOI: 10.1111/apt.17252.
    [48]
    RUSSO MW, ZACKS SL, SANDLER RS, et al. Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding[J]. Hepatology, 2000, 31(2): 358-363. DOI: 10.1002/hep.510310215.
    [49]
    HARMAN DJ, MCCORRY RB, JACOB RP, et al. Economic modelling of early transjugular intrahepatic portosystemic shunt insertion for acute variceal haemorrhage[J]. Eur J Gastroenterol Hepatol, 2013, 25(2): 201-207. DOI: 10.1097/MEG.0b013e32835a4cb0.
    [50]
    RÖSSLE M. Liver: Early TIPS in patients with cirrhosis and variceal bleeding[J]. Nat Rev Gastroenterol Hepatol, 2010, 7(10): 536-538. DOI: 10.1038/nrgastro.2010.147.
    [51]
    HUNG ML, LEE EW. Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension: review and update of the literature[J]. Clin Liver Dis, 2019, 23(4): 737-754. DOI: 10.1016/j.cld.2019.07.004.
    [52]
    HAYES PC, MOOKERJEE RP. Early TIPS for portal hypertensive related bleeding: Is resource or education the reason for failure to show clear survival benefit?[J]. J Hepatol, 2017. DOI: 10.1016/j.jhep.2017.11.001.[Onlineahead of print]
    [53]
    THABUT D, RUDLER M. Pre-emptive TIPS in high-risk patients with cirrhosis and variceal bleeding: is it finally time for a conclusion?[J]. Lancet Gastroenterol Hepatol, 2019, 4(8): 572-573. DOI: 10.1016/S2468-1253(19)30172-4.
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