Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage

Table 1 Transjugular intrahepatic portosystemic shunt vs endoscopic therapy in the prevention of rebleeding: Results from meta-analyses n (%)

Study finding	Reference, value
	Burroughs et al[34]	Zheng et al [35]
Patients	948	883
TIPS	472	440
Endoscopic therapies	476	443
Randomized controlled trials	13	12
Recurrent bleeding
TIPS	88 (18.6)	86 (19.0)
Endoscopic therapy	210 (44.1)	194 (43.8)
OR (95%CI) for TIPS	0.30 (0.21-0.44)	0.32 (0.24-0.43)
Post-treatment encephalopathy
TIPS	134 (28.4)	148 (33.6)
Endoscopic therapy	83 (17.4)	86 (19.4)
OR (95%CI) for TIPS	2.08 (1.49-2.94)	2.21 (1.61-3.03)
All-cause mortality
TIPS	130 (27.5)	111 (25.2)
Endoscopic therapy	118 (24.8)	98 (22.1)
OR (95%CI) for TIPS	1.14 (0.85-1.54)	1.17 (0.85-1.61)

TIPS: Transjugular intrahepatic portosystemic shunt.

Table 2 Contraindications to placement of a transjugular intrahepatic portosystemic shunt

Absolute	Relative
Congestive heart failure	Portal vein thrombosis
Severe pulmonary hypertension	Hepatocellular carcinoma
Severe systemic sepsis	Severe coagulopathy
Unrelieved biliary obstruction	Hepatic encephalopathy
Severe tricuspid regurgitation	Obstruction of all hepatic veins

Table 3 Acute and chronic complications after transjugular intrahepatic portosystemic shunt placement

Acute complications	Acute complications	Chronic complications
Minor or moderate	Life-threatening	Portal vein thrombosis
Stent displacement	Hemobilia	Congestive heart failure
Neck hematoma	Hemoperitoneum	Progressive liver failure
Arrhythmia	Cardiac failure	Chronic recurrent encephalopathy
Shunt thrombosis	Liver ischemia	Stent dysfunction
Hepatic vein obstruction	Sepsis

Table 4 Risk factors for post-transjugular intrahepatic portosystemic shunt encephalopathy

Risk factors
Age
Sex
Cause
Child-Pugh score
Hepatic encephalopathy history TIPS
Porto-hepatic gradient
Stent diameter
Indication
Creatinine