Trans-jugular intrahepatic portosystemic stent shunting benefits and limits

Abstract

Trans-jugular intrahepatic portosystemic stent shunting (TIPSS) has been in use for many years with great results and many evolutions. The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt. Over time, TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension. From the outset, this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery. Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy, in fact this method is applicable to many patients with severe liver disease not suitable for it. TIPSS has been studied for the management of variceal bleeding, ascites, hepatic hydrothorax, hepatorenal syndrome, and other types of cirrhosis. However, some drawbacks of the TIPSS, such as shunt stenosis and hepatic encephalopathy, have also been reported in the literature. On the basis of the available evidence and the new epidemiological findings regarding liver disease, the following question may be posed: What is the place of TIPSS in current clinical practice?

Keywords: Hepatic compensation; Decompensation; Trans-jugular intrahepatic portosystemic stent-shunt; Bleeding; Ascites

Core Tip: The main topic of this article is whether trans-jugular intrahepatic portosystemic stent shunting can be considered a useful strategy for liver recompensation, following the new recommendations of the Baveno guidelines and clinical experience.