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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2021; 27(44): 7612-7624
Published online Nov 28, 2021. doi: 10.3748/wjg.v27.i44.7612
Published online Nov 28, 2021. doi: 10.3748/wjg.v27.i44.7612
Role of early transjugular intrahepatic portosystemic stent-shunt in acute variceal bleeding: An update of the evidence and future directions
Faisal Khan, Gastroenterology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
Dhiraj Tripathi, Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
Dhiraj Tripathi, NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham, NHS Foundation Trust and University of Birmingham, Birmingham B15 2TH, United Kingdom
Dhiraj Tripathi, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, United Kingdom
Author contributions: Khan F performed research and wrote the manuscript; Tripathi D contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: Khan F has no conflict of interest. Tripathi D receives Speaker fees and consultancy for Gore Medical, and Research grant award for early TIPSS trial (NIHR, UK).
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dhiraj Tripathi, FRCP, MBChB, MD, Attending Doctor, Professor, Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom. d.tripathi@bham.ac.uk
Received: April 19, 2021
Peer-review started: April 19, 2021
First decision: May 12, 2021
Revised: May 27, 2021
Accepted: October 29, 2021
Article in press: October 29, 2021
Published online: November 28, 2021
Peer-review started: April 19, 2021
First decision: May 12, 2021
Revised: May 27, 2021
Accepted: October 29, 2021
Article in press: October 29, 2021
Published online: November 28, 2021
Core Tip
Core Tip: Outcome of high-risk patients following episode of acute variceal bleeding (AVB) is poor and insertion of transjugular intrahepatic portosystemic stent-shunt (TIPSS) within 72 h of index endoscopy (early or pre-emptive TIPSS) is associated with remarkable outcomes in a selection of patients (Child C up to 13 points). However, it’s efficacy in Child B patients is debatable and criteria for high-risk patients needs to be refined. Moreover, management of variceal bleeding has improved in last decade and provision of early TIPSS (within 72 h) is challenging in most healthcare facilities. In this paper we have discussed the role of early TIPSS, patient selection and future directions in management of AVB.