Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review

Lahat, Eylon; Lim, Chetana; Bhangui, Prashant; Fuentes, Liliana; Osseis, Michael; Moussallem, Toufic; Salloum, Chady; Azoulay, Daniel

doi:10.1016/j.hpb.2017.09.006

Cited by 34 publications

(23 citation statements)

References 49 publications

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“…There is a marked paucity of data. A recent systematic review studied all fully published studies 3. All publications are retrospective in nature.…”

Section: Indications For Tipssmentioning

confidence: 99%

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Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Tripathi

Stanley

Hayes

et al. 2020

Gut

228

220

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These guidelines on transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of portal hypertension have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the Liver Section of the BSG. The guidelines are new and have been produced in collaboration with the British Society of Interventional Radiology (BSIR) and British Association of the Study of the Liver (BASL). The guidelines development group comprises elected members of the BSG Liver Section, representation from BASL, a nursing representative and two patient representatives. The quality of evidence and grading of recommendations was appraised using the GRADE system. These guidelines are aimed at healthcare professionals considering referring a patient for a TIPSS. They comprise the following subheadings: indications; patient selection; procedural details; complications; and research agenda. They are not designed to address: the management of the underlying liver disease; the role of TIPSS in children; or complex technical and procedural aspects of TIPSS.

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“…There is a marked paucity of data. A recent systematic review studied all fully published studies 3. All publications are retrospective in nature.…”

Section: Indications For Tipssmentioning

confidence: 99%

“…There is increasing importance of careful patient selection, and we believe that this requires particular attention in light of emerging data. We are also aware of rarer indications for TIPSS, which may have more of a place in routine practice 2–4. Unless stated otherwise, all sections are with reference to covered TIPSS.…”

Section: Introductionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Tripathi

Stanley

Hayes

et al. 2020

Gut

228

220

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“…Bislang publizierte Studien zum TIPS als neoadjuvantes Verfahren bei Zirrhosepatienten mit elektiver viszeralchirurgischer Operation und hohem Risiko für eine postoperative hydropische Dekompensation zeigen vielversprechende Ergebnisse, wobei bisher nur auf Einzelfallberichte und retrospektive Erhebungen zurückgegriffen werden kann [118][119][120][121]. In der größten bekannten publizierten Kohorte wurden 66 Patienten mit TIPS mittels Propensity Score Matching mit 68 Patienten ohne TIPS retrospektiv verglichen [120].…”

Section: Präoperativer Tipsunclassified

30 Jahre transjugulärer intrahepatischer portosystemischer Shunt (TIPS) – Rückblick und Perspektive

et al. 2020

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ZusammenfassungDer transjuguläre intrahepatische portosystemische Shunt (TIPS) wird seit 30 Jahren in der Therapie der portalen Hypertonie erfolgreich eingesetzt. In nationalen und internationalen Leitlinien ist die Indikation zur TIPS-Anlage bei Varizenblutung und refraktärem Aszites wissenschaftlich gut belegt und klar definiert. Bei seltenen Indikationen wie dem hepatorenalen Syndrom, der Pfortaderthrombose oder dem neoadjuvanten Einsatz fehlt derzeit noch eine eindeutige Studienlage. Eine wichtige Kontraindikation und klinisch bedeutendste Komplikation nach TIPS ist die hepatische Enzephalopathie (HE). Es wird versucht, die Post-TIPS HE mit technischen Weiterentwicklungen der Stents zu reduzieren.

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“…Preoperative TIPS cannot be routinely recommended but can act as a bridge to surgery in patients with medically refractory ascites. [68][69][70] Given that it takes weeks to take effect, it should likely not play a role in the management of ascites in surgical emergencies, although there is some anecdotal evidence for its use in the nonelective setting. 55,69…”

Section: Ascitesmentioning

confidence: 99%

Management of Patients with Cirrhosis and Portal Hypertension Requiring Surgery

Carpenter

Liou

Mathur

2020

Digestive Disease Interventions

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Cirrhosis significantly increases surgical morbidity and mortality as it causes derangement of multiple organ systems and physiological processes. As such, chronic liver disease and the resultant portal hypertension present distinct perioperative challenges. The risk conveyed by liver disease is dependent on its etiology, the severity of liver dysfunction, the degree to which other organ systems are affected, and the type and timing of surgery to be performed. Careful preoperative planning as well as informed intra- and postoperative decision-making strategies are key factors in ensuring acceptable outcomes in the surgical management of cirrhotic patients. This review will discuss the challenges that cirrhosis with portal hypertension presents to the surgeon, intensivist, and anesthesiologist alike, and identifies key perioperative strategies to mitigate these risks.

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Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review

Abstract: TIPS allows non-hepatic surgery in cirrhotic patients deemed non operable due to PHTN. Further evidence in larger cohort of patients is essential for wider applicability.

Cited by 34 publications

References 49 publications

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

30 Jahre transjugulärer intrahepatischer portosystemischer Shunt (TIPS) – Rückblick und Perspektive

Management of Patients with Cirrhosis and Portal Hypertension Requiring Surgery

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