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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Dec 7, 2014; 20(45): 16996-17010
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16996
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16996
Table 1 Contraindications to transjugular intrahepatic portosystemic shunts placement according to current American Association for the Study of Liver Diseases guidelines
Absolute | Relative |
Congestive heart failure | Hepatoma especially if central |
Multiple hepatic cysts | Obstruction of all hepatic veins |
Uncontrolled systemic infection or sepsis | Portal vein thrombosis |
Unrelieved biliary obstruction | Severe coagulopathy (INR > 5) |
Severe pulmonary hypertension | Thrombocytopenia of < 20000/cm3 |
Moderate pulmonary hypertension |
Table 2 Results of 3 trials comparing early transjugular intrahepatic portosystemic shunts placement and standard treatment (combined pharmacologic and endoscopic therapy) in high-risk acute variceal bleeding
Findings | Ref. | |||||
Monescillo et al[44], 2004 | García-Pagán et al[45], 2010 | Garcia-Pagán et al[46], 2012 | ||||
Early TIPS | Standard care | Early TIPS | Standard care | Early TIPS | Standard care | |
Patients | 26 | 26 | 32 | 31 | 45 | 30 |
Treatment failure1 | 12% | 50% | 3% | 45% | 7% | 50% |
Early rebleeding (< 5 d) | 4% | 12% | 3% | 13% | 2% | 13% |
1-yr mortality rate | 31% | 65% | 14% | 39% | 14%3 | 30% |
Development of hepatic encephalopathy2 | 31% | 35% | 25% | 39% | 51% | 50% |
Table 3 Results of 6 randomized controlled trials comparing transjugular intrahepatic portosystemic shunts and large volume paracentesis for refractory ascites
Ref. | Number of patients | Complete resolution of ascites within 6 mo1 | Treatment failure2 | Survival at 2 yr | Newly developed or severe encephalopathy | |||||||||
TIPS | LVP | TIPS | LVP | P-value | TIPS | LVP | P-value | TIPS | LVP | P-value | TIPS | LVP | P-value | |
Lebrec et al[98] 1996 | 13 | 12 | 38% | 0% | < 0.05 | NR | 29% | 60% | 0.03 | 45% | 0% | < 0.05 | ||
Rössle et al[100], 2000 | 29 | 31 | 52% | 16% | 0.001 | 10% | 48% | 0.001 | 58% | 32% | 0.11 | 23% | 13% | NS |
Ginès et al[97], 2002 | 35 | 35 | NR | 49% | 83% | 0.003 | 26% | 30% | 0.51 | 60% | 34% | 0.03 | ||
Sanyal et al[102], 2003 | 52 | 57 | NR | 42% | 84% | < 0.001 | 35% | 33% | 0.84 | 38% | 21% | 0.058 | ||
Salerno et al[101], 2004 | 33 | 33 | 60%3 | 3% | < 0.001 | 21% | 57% | 0.001 | 59% | 29% | 0.021 | 61% | 39% | NS |
Narahara et al[99], 2011 | 30 | 30 | 30% | 0% | < 0.005 | 13% | 80% | < 0.001 | 64% | 35% | < 0.005 | 67% | 17% | < 0.001 |
Table 4 Case series of transjugular intrahepatic portosystemic shunts for refractory hepatic hydrothorax
Ref. | No. of patients | Child-Pugh or MELD score | Efficacy (complete/partial response) | 30-d mortality | 1-yr survival | Predictor of mortality |
Strauss et al[112], 1994 | 5 | C: 5 | 80%/20% | NR | NR | NR |
Gordon et al[113], 1997 | 24 | B/C: 5/19 | 58%/21% | 21% | NR | Child C |
Non-response | ||||||
Jeffries et al[114], 1998 | 12 | A/B/C: 1/5/6 | 42%/17% | 25% | NR | Age > 65 |
Siegerstetter et al[115], 2001 | 40 | B/C: 24/16 | 71%/11% | NR | 64% | Age > 60 |
Spencer et al[116], 2002 | 21 | B/C: 7/14 | 63%/11% | 29% | NR | Multiple comorbidities |
Wilputte et al[117], 2007 | 28 | B/C: 12/16 | 57%/11% | 14% | 41% | Child-Pugh score |
Dhanasekaran et al[118], 2010 | 73 | MELD < 15: 32.8% | 59%/20.5%1 | 19% | 48% | Pre-TIPS MELD score Non-response |
MELD > 15: 67.2% | 60%/15%2 |
- Citation: Siramolpiwat S. Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications. World J Gastroenterol 2014; 20(45): 16996-17010
- URL: https://www.wjgnet.com/1007-9327/full/v20/i45/16996.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i45.16996