Current use of transjugular intrahepatic portosystemic shunts

McCashland, Timothy M.

doi:10.1007/s11894-003-0007-9

Cited by 5 publications

(4 citation statements)

References 111 publications

(85 reference statements)

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“…In contrast, GAVE does not resolve after lowering portal pressure with TIPS, and GAVE is, therefore, likely related to hepatic dysfunction rather than portal hypertension [78] . TIPS also decreased the risk of PHG bleeding [75][76][77]100,[249][250][251][252][253] . For example, Kamath et al [75] reported TIPS led to improvement or resolution of PHG findings and decreased transfusion requirements from 2.9 ± 2.0 (SD) units/mo of packed erythrocytes before TIPS to 0.6 ± 0.8 units/mo after TIPS performed for severe PHG (P = 0.04).…”

Section: Summary Of Clinical Treatmentmentioning

confidence: 89%

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Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

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Section: Summary Of Clinical Treatmentmentioning

confidence: 89%

“…TIPS reduces the frequency and severity of PHG because it lowers portal pressure [76] . PHG can sometimes resolve completely after TIPS [75][76][77][249][250][251][252][253] . Urata et al [77] reported in a prospective study of 12…”

Section: Summary Of Clinical Treatmentmentioning

confidence: 99%

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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“…TIPS creation was performed in all patients as previously described [1][2][3][4]15 and included transjugular catheterization of the portal vein. The portal vein was punctured, pressures measured in its main stem and the inferior vena cava above the hepatic veins, the needle track dilated using a balloon catheter, and one to 3 stents (Wallstent; Boston Scientiˆc, Natick, MA, USA) placed.…”

Section: Tipsmentioning

confidence: 99%

“…Recent reports indicate one-year mortality rates between 10z to 54z [1][2][3][4] and 30-day mortality as high as 55z 5 ; various complications after TIPS creation, such as shunt dysfunction and onset or worsening of hepatic encephalopathy, [1][2][3][4] can worsen patient quality of life (QOL); and technical di‹culties in the TIPS procedure diŠer from patient to patient.…”

Section: Introductionmentioning

confidence: 99%

MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

Yoshikawa

Mitchell

2011

magn reson med sci

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Purpose: We assessed whether magnetic resonance (MR) imaging evaluation of portosystemic collateral shunts can aid prediction of therapeutic eŠectiveness and complications after creation of a transjugular portosystemic shunt (TIPS), and technical di‹culty during the TIPS procedure.Materials and Methods: We retrospectively reviewed 32 patients (27 men, 5 women; mean age, 56.4 years) who underwent TIPS creation following gadolinium-enhanced MR examination. We measured the diameters of pre-existing portosystemic collateral shunting vessels, added the measurements together to generate a shunting collateral score for each patient, and divided patients into 2 groups by score of 4 or greater or less than 4. We then compared therapeutic eŠectiveness, technical di‹culty and complications of the TIPS procedure, and portal venous (PV) pressure, PV-inferior vena cava (IVC) pressure gradient, and PV diameter between the groups.Results: The patients with a pre-existing large portosystemic shunt showed insigniˆcant trends toward higher technical di‹culty of the shunt procedure and rate of shunt dysfunction. The 2 groups showed no signiˆcant diŠerence in early mortality rate, onset or worsening rate of hepatic encephalopathy after TIPS creation, PV pressure, PV-IVC pressure gradient, or PV diameter.Conclusion: Gadolinium-enhanced MR imaging may help in predicting technical di‹-culty and complications of TIPS.

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Portal Hypertension

Superina¹

2006

Pediatric Surgery

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Current use of transjugular intrahepatic portosystemic shunts

Cited by 5 publications

References 111 publications

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

Portal Hypertension

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