To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

Semin Liver Dis. 2023 May;43(2):189-205. doi: 10.1055/a-2107-0576. Epub 2023 Jun 7.

Abstract

Variceal bleeding is a consequence of severe portal hypertension in patients with liver cirrhosis. Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high risk of treatment failure and short-term mortality. Treatment and/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic portosystemic shunts (TIPSs), especially in the preemptive situation, have been found to efficiently control bleeding, prevent rebleeding, and reduce short-term mortality. Therefore, TIPS placement should be considered as an option in the management of ACLF patients with variceal bleeding.

MeSH terms

  • Acute-On-Chronic Liver Failure* / etiology
  • Acute-On-Chronic Liver Failure* / therapy
  • Esophageal and Gastric Varices* / etiology
  • Esophageal and Gastric Varices* / therapy
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy
  • Humans
  • Liver Cirrhosis / complications
  • Portasystemic Shunt, Transjugular Intrahepatic* / adverse effects
  • Treatment Outcome