"Salvage" Transjugular Intrahepatic Portosystemic Shunts: Gastric Fundal Compared With Esophageal Variceal Bleeding

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

“…Although it had been suggested that bleeding from gastric varices was more difficult to control with TIPS than bleeding from esophageal varices, a prospective study compared salvage TIPS in patients with uncontrolled gastric fundal (n ϭ 28) versus uncontrolled esophageal (n ϭ 84) variceal bleeding and showed equal efficacy with control of hemorrhage in all but one patient in each group. 114 The threshold to place TIPS for gastric variceal hemorrhage is lower than for esophageal variceal hemorrhage and TIPS can be recommended if endoscopic therapy is not possible or after a single failure of endoscopic treatment.…”

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

“…In some series, the initial HVPG in patients with gastric varices was lower than that of patients with esophageal varices, whereas in other series no differences were observed. [81][82][83] In these small series, TIPS was equally effective at controlling bleeding from gastric as well as esophageal varices. [81][82][83][84] Controlled trials comparing surgical shunts or glue in the treatment of these patients would help to better define the role of TIPS in the management of patients with bleeding from gastric varices.…”

“…[81][82][83] In these small series, TIPS was equally effective at controlling bleeding from gastric as well as esophageal varices. [81][82][83][84] Controlled trials comparing surgical shunts or glue in the treatment of these patients would help to better define the role of TIPS in the management of patients with bleeding from gastric varices. In the authors' opinion, TIPS is an important tool in the control of gastric variceal bleeding, though the final portosystemic gradient required to achieve variceal decompression may be lower than what is required for esophageal variceal bleeding, and embolization of the varices also may be required.…”

Indications for Use of TIPS in Treating Portal Hypertension

“…TIPS procedures are best studied in this patient population and have been shown to eradicate esophageal varices effectively. The shunts are successful in the treatment of esophageal variceal bleeding that is refractory to firstline endoscopic and pharmacologic therapy, especially in patients who are poor candidates for surgery [1][2][3][4][5]. The procedure is more effective in secondary prevention of rebleeding than endoscopic and medical therapy, although at the expense of increased encephalopathy, the risk of procedural complications, and likelihood of no improvement in overall survival [1,[6][7][8][9][10].…”

“…In general, choosing among endoscopy therapy, TIPS, or surgical shunt for acute variceal bleeding or secondary prophylaxis should be based upon the individual patient's bleeding, encephalopathy, and surgical risks. Bleeding from gastric or ectopic varices or PHG has been shown to improve with TIPS, although this is not yet well studied [5].…”