de Mattos AA, de Mattos AZ, Manica M, Tovo CV. Which patients benefit the most? An update on transjugular intrahepatic portosystemic shunt. World J Hepatol 2025; 17(2): 99809 [DOI: 10.4254/wjh.v17.i2.99809]
Corresponding Author of This Article
Cristiane Valle Tovo, MD, PhD, Research Assistant Professor, Research Associate, Research Scientist, Postgraduation Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite 245, Porto Alegre 90050-170, Rio Grande do Sul, Brazil. cristianev@ufcspa.edu.br
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion 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 Hepatol. Feb 27, 2025; 17(2): 99809 Published online Feb 27, 2025. doi: 10.4254/wjh.v17.i2.99809
Which patients benefit the most? An update on transjugular intrahepatic portosystemic shunt
Angelo Alves de Mattos, Angelo Zambam de Mattos, Muriel Manica, Cristiane Valle Tovo
Angelo Alves de Mattos, Angelo Zambam de Mattos, Muriel Manica, Cristiane Valle Tovo, Postgraduation Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Author contributions: Mattos AA conceptualized, designed and wrote the manuscript; Mattos AZ, Manica M and Tovo CV wrote the manuscript; Mattos AA, Matos AZ, Manica M and Tovo CV critically reviewed the manuscript for important intellectual content; all authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare not have conflict of interest of any kind for the realization of this study.
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: Cristiane Valle Tovo, MD, PhD, Research Assistant Professor, Research Associate, Research Scientist, Postgraduation Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite 245, Porto Alegre 90050-170, Rio Grande do Sul, Brazil. cristianev@ufcspa.edu.br
Received: July 31, 2024 Revised: December 23, 2024 Accepted: January 9, 2025 Published online: February 27, 2025 Processing time: 204 Days and 2.8 Hours
Abstract
This is a narrative review in which the advances in technical aspects, the main indications, limitations and clinical results of the transjugular intrahepatic portosystemic shunt (TIPS) in portal hypertension (PH) are addressed. With the emergence of the coated prosthesis, a better shunt patency, a lower incidence of hepatic encephalopathy (HE) and better survival when compared to TIPS with the conventional prosthesis are demonstrated. The main indications for TIPS are refractory ascites, acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and, lastly, patients considered at high risk for rebleeding preemptive TIPS (pTIPS). Absolute contraindications to the use of TIPS are severe uncontrolled HE, systemic infection or sepsis, congestive heart failure, severe pulmonary arterial hypertension, and biliary obstruction. The control of hemorrhage due to variceal rupture can reach up to 90%-100% of cases, and 55% in refractory ascites. Despite evidences regarding pTIPS in patients at high risk for rebleeding, less than 20% of eligible patients are treated. TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients. In conclusion, TIPS is an essential treatment for patients with PH, but is often neglected. It is important for the hepatologist to form a multidisciplinary team, in which the role of the radiologist with experience in interventional procedures is prominent.
Core Tip: This is a narrative review where the advances in technical aspects, the main indications, limitations and clinical results of the transjugular intrahepatic portosystemic shunt (TIPS) in portal hypertension (PH) are addressed. With the coated prosthesis, a better shunt patency, a lower incidence of hepatic encephalopathy and better survival when compared to the not covered prosthesis are demonstrated. The main indications for TIPS are refractory ascites, acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and, lastly, patients considered at high risk for rebleeding preemptive TIPS. In conclusion, TIPS is an essential treatment for patients with PH, but is often neglected.
