Transjugular intrahepatic portosystemic shunt and non-selective beta-blockers act as friends or foe in decompensated cirrhosis: A comparative review

Table 1 Comparisons between nonselective beta-blockers and transjugular intrahepatic portosystemic shunt

Aspect	NSBBs	TIPS
Mechanism of action	Decreases cardiac output and induces splanchnic vasoconstriction to lower the portal pressure	Creates a channel between the portal and hepatic veins to reduce the portal pressure
Primary indications	Prevention of first and recurrent variceal bleeding	Management of portal hypertension complications such as variceal bleeding, refractory ascites, and hepatic hydrothorax
Efficacy	Effective in reducing variceal bleeding risk	Highly effective in controlling variceal bleeding and managing refractory ascites
Procedure	Non-invasive medications	Minimally invasive procedures performed by interventional radiologists
Side-effects	Bradycardia, hypotension, fatigue, exacerbation of asthma or COPD, paracentesis-induced circulatory dysfunction, and potential worsening of ascites	Risk factors of hepatic encephalopathy, shunt dysfunction, infection, and procedure-related complications
Survival impact	This can improve the survival of patients with high-risk varices	It can improve survival, particularly in patients with refractory ascites or those at a high risk of variceal rebleeding
Cost	Relatively low-cost as it involves medication	Expensive; Higher costs are attributed to the need for interventional procedures and possible subsequent shunt revisions
Follow-up and maintenance	Regular monitoring of heart rate, blood pressure, and dose adjustments may be necessary	Regular follow-up for shunt patency may require repeat imaging or interventions to maintain shunt function
Impact on hepatic encephalopathy	They can help reduce the incidence of hepatic encephalopathy when used appropriately	This involves a higher risk of postprocedural hepatic encephalopathy
Combination therapy	These are often combined with endoscopic treatment to achieve better outcomes	This may be combined with NSBBs to manage residual varices or incomplete portal decompression after the procedure
Clinical guidelines	American Association for the Study of Liver Diseases and the European Association for the Study of the Liver recommend it for the prevention of variceal bleeding	The American Association for the Study of Liver Diseases and the European Association for the Study of the Liver recommend this for managing refractory complications of portal hypertension

NSBBs: Nonselective beta-blockers; TIPS: Transjugular intrahepatic portosystemic shunt; COPD: Chronic obstructive pulmonary disease.