Rajesh S, George T, Philips CA, Ahamed R, Kumbar S, Mohan N, Mohanan M, Augustine P. Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update. World J Gastroenterol 2020; 26(37): 5561-5596 [PMID: 33088154 DOI: 10.3748/wjg.v26.i37.5561]
Corresponding Author of This Article
Cyriac Abby Philips, MBBS, MD, DM, Consultant Physician-Scientist, The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, NH-Bypass, Palarivattom, Kochi 682028, Kerala, India. abbyphilips@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 7, 2020; 26(37): 5561-5596 Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5561
Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update
Sasidharan Rajesh, Tom George, Cyriac Abby Philips, Rizwan Ahamed, Sandeep Kumbar, Narain Mohan, Meera Mohanan, Philip Augustine
Sasidharan Rajesh, Tom George, Division of Hepatobiliary Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Cyriac Abby Philips, Narain Mohan, The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Rizwan Ahamed, Sandeep Kumbar, Philip Augustine, Gastroenterology and Advanced GI Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Meera Mohanan, Anesthesia and Critical Care, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
Author contributions: Rajesh S designed the study and wrote manuscript and was involved in revision, editing and review; George T was involved in writing, editing and reformatting of the manuscript; Philips CA was involved in the writing, revision and editing of the manuscript; Ahamed R was involved in the review and editing of the manuscript; Kumbar S was involved in the editing and review of the manuscript; Mohan N was involved in the editing and review of the manuscript; Mohanan M was involved in the editing and review of the manuscript; Augustine P was involved in the editing and review of the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: None to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Cyriac Abby Philips, MBBS, MD, DM, Consultant Physician-Scientist, The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, NH-Bypass, Palarivattom, Kochi 682028, Kerala, India. abbyphilips@gmail.com
Received: June 5, 2020 Peer-review started: June 5, 2020 First decision: July 25, 2020 Revised: July 31, 2020 Accepted: August 29, 2020 Article in press: August 29, 2020 Published online: October 7, 2020 Processing time: 114 Days and 15 Hours
Core Tip
Core Tip: Covered transjugular intrahepatic portosystemic shunt has proven effective in ameliorating the symptoms associated with cirrhosis and portal hypertension in a subset of patients. However, hepatic encephalopathy (HE) and deterioration of liver function remain a concern. The meticulous selection of patients is the most fruitful measure to improve patient outcomes. While patients having preserved hepatic and renal functions and without any prior history of, HE and cardiopulmonary disease are ideal candidates, patients with high liver disease severity scores, poor cardiac reserve, and risk of HE should be considered for transjugular intrahepatic portosystemic shunt only as a last resort or a bridge to transplant. With the advent of controlled expansion stent, and improvements in patient selection criteria, the incidence of HE and early liver failure is expected to reduce further.
