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Role of early transjugular intrahepatic portosystemic stent-shunt in acute variceal bleeding:An update of the evidence and future directions

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World Journal of Gastroenterology 2021年第44期27卷 7612-7624页

作者： Faisal Khan Dhiraj Tripathi Gastroenterology Unit University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUnited Kingdom Liver Unit University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUnited Kingdom NIHR Birmingham Biomedical Research Centre University Hospitals BirminghamNHS Foundation Trust and University of BirminghamBirmingham B152THUnited Kingdom Institute of Immunology and Immunotherapy University of BirminghamBirmingham B152THUnited Kingdom

variceal bleeding is a serious complication of cirrhosis and portal *** the improvement in management of acute variceal bleed(AVB),it still carries significant *** pressure is the main driver of variceal bleeding and also a main predictor of *** in portal pressure has been the mainstay of management of variceal *** intrahepatic porto-systemic stent shunt(TIPSS)is a very effective modality in reducing the portal hypertension and thereby,controlling portal hypertensive ***,its use in refractory bleeding(rescue/salvage TIPSS)is still associated with high mortality.“Early”use of TIPSS as a“pre-emptive strategy”in patients with AVB at high risk of failure of treatment has shown to be superior to standard treatment in several *** patients with Child C cirrhosis(up to 13 points)clearly benefit from early-TIPSS strategy,it’s role in less severe liver disease(Child B)and more severe disease(Child C>13 points)remains less ***,standard of care has improved in the last decade leading to improved 1-year survival in high-risk patients with AVB as compared to earlier“early”TIPSS *** in the real world,only a minority of patients with AVB fulfil the stringent criteria for early ***,there is unmet need to explore role of early TIPSS in management of AVB in well-designed prospective studies. In this review, we have appraised the role of early TIPSS, patient selection anddiscussed future directions in the management of patients with AVB.

关键词： Transjugular intrahepatic portosystemic stent-shunt Early transjugular intrahepatic portosystemic stent-shunt Salvage transjugular intrahepatic portosystemic stent-shunt Portal hypertension acute variceal bleed Hepatic encephalopathy

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