2020
DOI: 10.1136/gutjnl-2019-320221
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Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Abstract: 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 … Show more

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Cited by 228 publications
(254 citation statements)
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References 185 publications
(269 reference statements)
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“…This is echoed in the recent UK TIPSS guidelines for the management of portal hypertension, in addition to highlighting the uncertainties in patient selection for the procedure. 29 …”
Section: Discussionmentioning
confidence: 99%
“…This is echoed in the recent UK TIPSS guidelines for the management of portal hypertension, in addition to highlighting the uncertainties in patient selection for the procedure. 29 …”
Section: Discussionmentioning
confidence: 99%
“…Even though the question of survival benefit in patients with Child-Pugh class B and MELD score of 12-18 remains open to debate, the reduction in rebleeding and ascites, without increasing the risk or severity of HE could also justify the use of early TIPS in this subgroup of patients. In keeping with this, the British society of interventional radiology and British association of the study of the liver recommends that "in patients who have Child’s C disease (C 10-13) or MELD ≥ 19, and bleeding from esophageal varices (EV) or GOV1 and GOV2 gastric varices (GV) and are hemodynamically stable, early or pre-emptive TIPS should be considered within 72 h of a variceal bleed where local resources allow"[ 22 ]. Despite these recom-mendations, the rate of implementation of early TIPS in a real-world situation is dismal, with only 6%-13% of eligible candidates undergoing the procedure according to two recent large multicentre observational studies[ 23 , 24 ].…”
Section: Established and Emerging Indications For Tipsmentioning
confidence: 99%
“…The 1-year rate of recurrent VH is approximately 60% in patients without treatment, with a mortality rate approaching 30%[ 25 ]. It is recommended that endoscopic band ligation (EBL), in combination with non-selective beta-blockers (NSBB), be the first line of therapy for the prevention of recurrent VH with reservation of TIPS only for non-responders[ 15 , 22 ]. In this regard, two RCTs compared covered stents with EBL[ 26 , 27 ].…”
Section: Established and Emerging Indications For Tipsmentioning
confidence: 99%
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“…Of note, the parameter age is not particularly mentioned [4]. However, TIPS insertion in elderly patients is supposed to be performed with great caution, since it might increase the risk for HE in patients of higher age [7]. In fact, higher age is even considered as a contraindication in many centers [8].…”
Section: Introductionmentioning
confidence: 99%