Transjugular intrahepatic portosystemic shunt: Difference between revisions
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==Effectiveness== | ==Effectiveness== | ||
TIPSS was [[systematic review|systematically reviewed]] by the [[Cochrane Collaboration]] who concluded that "TIPS was more effective at removing ascites as compared with paracentesis...however, TIPS patients develop hepatic encephalopathy significantly more often"<ref name="pmid17054221">{{cite journal |author=Saab S, Nieto JM, Lewis SK, Runyon BA |title=TIPS versus paracentesis for cirrhotic patients with refractory ascites |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD004889 |year=2006 |pmid=17054221 |doi=10.1002/14651858.CD004889.pub2}}</ref> An individual patient data [[meta-analysis]] concluded similarly.<ref name="pmid17678653">{{cite journal| author=Salerno F, Cammà C, Enea M, Rössle M, Wong F| title=Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. | journal=Gastroenterology | year= 2007 | volume= 133 | issue= 3 | pages= 825-34 | pmid=17678653 | TIPSS was [[systematic review|systematically reviewed]] by the [[Cochrane Collaboration]] who concluded that "TIPS was more effective at removing ascites as compared with paracentesis...however, TIPS patients develop hepatic encephalopathy significantly more often"<ref name="pmid17054221">{{cite journal |author=Saab S, Nieto JM, Lewis SK, Runyon BA |title=TIPS versus paracentesis for cirrhotic patients with refractory ascites |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD004889 |year=2006 |pmid=17054221 |doi=10.1002/14651858.CD004889.pub2}}</ref> An individual patient data [[meta-analysis]] concluded similarly.<ref name="pmid17678653">{{cite journal| author=Salerno F, Cammà C, Enea M, Rössle M, Wong F| title=Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. | journal=Gastroenterology | year= 2007 | volume= 133 | issue= 3 | pages= 825-34 | pmid=17678653 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17678653 | doi=10.1053/j.gastro.2007.06.020 }} | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17678653 | doi=10.1053/j.gastro.2007.06.020 }}></ref> | ||
TIPSS was better than peritoneovenous shunt in a [[randomized controlled trial]].<ref name="pmid15166968">{{cite journal| author=Rosemurgy AS, Zervos EE, Clark WC, Thometz DP, Black TJ, Zwiebel BR et al.| title=TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial. | journal=Ann Surg | year= 2004 | volume= 239 | issue= 6 | pages= 883-9; discussion 889-91 | pmid=15166968 | TIPSS was better than peritoneovenous shunt in a [[randomized controlled trial]].<ref name="pmid15166968">{{cite journal| author=Rosemurgy AS, Zervos EE, Clark WC, Thometz DP, Black TJ, Zwiebel BR et al.| title=TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial. | journal=Ann Surg | year= 2004 | volume= 239 | issue= 6 | pages= 883-9; discussion 889-91 | pmid=15166968 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15166968 | pmc=PMC1356297 }} < | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15166968 | pmc=PMC1356297 }}</ref> | ||
TIPSS may also add to endoscopic therapy for acute bleeding of [[esophageal varices]].<ref>{{Cite journal | |||
| doi = 10.1056/NEJMoa0910102 | volume = 362 | issue = 25 | pages = 2370-2379 | last = Garcia-Pagan | |||
| first = Juan Carlos | coauthors = Karel Caca, Christophe Bureau, Wim Laleman, Beate Appenrodt, Angelo Luca, Juan G. Abraldes, Frederik Nevens, Jean Pierre Vinel, Joachim Mossner, Jaime Bosch, the Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group | title = Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding | journal = N Engl J Med | accessdate = 2010-06-25 | date = 2010-06-24 | url = http://content.nejm.org/cgi/content/abstract/362/25/2370 }}</ref> | |||
==Adverse effects== | ==Adverse effects== | ||
Revision as of 20:02, 24 June 2010
In medicine, transjugular intrahepatic portasystemic shunt (TIPSS) is "A type of surgical portasystemic shunt to reduce portal hypertension with associated complications of esophageal varices and ascites. It is performed percutaneously through the jugular vein and involves the creation of an intrahepatic shunt between the hepatic vein and portal vein. The channel is maintained by a metallic stent. The procedure can be performed in patients who have failed sclerotherapy and is an additional option to the surgical techniques of portocaval, mesocaval, and splenorenal shunts. It takes one to three hours to perform.[1][2]
Effectiveness
TIPSS was systematically reviewed by the Cochrane Collaboration who concluded that "TIPS was more effective at removing ascites as compared with paracentesis...however, TIPS patients develop hepatic encephalopathy significantly more often"[3] An individual patient data meta-analysis concluded similarly.[4]
TIPSS was better than peritoneovenous shunt in a randomized controlled trial.[5]
TIPSS may also add to endoscopic therapy for acute bleeding of esophageal varices.[6]
Adverse effects
TIPSS worsens the MELD score[7] and TIPSS Patients with a MELD Score of 18 or more have a lower survival after TIPSS[8]; however, in both of these uncontrolled studies it is not clear whether TIPSS worsens the MELD Score or reduces the survival in this group more than in patients without TIPSS.
References
- ↑ Anonymous (2024), Transjugular intrahepatic portosystemic shunt (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Miller-Catchpole R (1995). "Diagnostic and therapeutic technology assessment. Transjugular intrahepatic portosystemic shunt (TIPS).". JAMA 273 (23): 1824-30. PMID 7776491.
- ↑ Saab S, Nieto JM, Lewis SK, Runyon BA (2006). "TIPS versus paracentesis for cirrhotic patients with refractory ascites". Cochrane database of systematic reviews (Online) (4): CD004889. DOI:10.1002/14651858.CD004889.pub2. PMID 17054221. Research Blogging.
- ↑ Salerno F, Cammà C, Enea M, Rössle M, Wong F (2007). "Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data.". Gastroenterology 133 (3): 825-34. DOI:10.1053/j.gastro.2007.06.020. PMID 17678653. Research Blogging. >
- ↑ Rosemurgy AS, Zervos EE, Clark WC, Thometz DP, Black TJ, Zwiebel BR et al. (2004). "TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial.". Ann Surg 239 (6): 883-9; discussion 889-91. PMID 15166968. PMC PMC1356297.
- ↑ Garcia-Pagan, Juan Carlos; Karel Caca, Christophe Bureau, Wim Laleman, Beate Appenrodt, Angelo Luca, Juan G. Abraldes, Frederik Nevens, Jean Pierre Vinel, Joachim Mossner, Jaime Bosch, the Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group (2010-06-24). "Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding". N Engl J Med 362 (25): 2370-2379. DOI:10.1056/NEJMoa0910102. Retrieved on 2010-06-25. Research Blogging.
- ↑ Choi DX, Jain AB, Orloff MS (2009). "Utility of transjugular intrahepatic portosystemic shunts in liver-transplant recipients.". J Am Coll Surg 208 (4): 539-46. DOI:10.1016/j.jamcollsurg.2009.01.008. PMID 19476787. Research Blogging.
- ↑ Ferral H, Gamboa P, Postoak DW, Albernaz VS, Young CR, Speeg KV et al. (2004). "Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score.". Radiology 231 (1): 231-6. DOI:10.1148/radiol.2311030967. PMID 14990811. Research Blogging.