FIRST CLINICAL-EXPERIENCE WITH TIPS (TRAN SJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT)

15 patients with predominantly alcoholtoxic liver cirrhosis (mean age 50 years; 8 men and 7 women) were treated by the technically successfu l implantation of a transjugular portosystemic stent-shunt (TIPS) with in a periods of 1 year. The indications for TIPS implantation were the following: gastroesophageal bleedings in 12 cases (10 patients with r ecurrent variceal bleeding including 2 emergency cases with serve blee ding resistant to conventional therapy and 2 patients with exclusively gastral bleeding due to serve hypertensive gastropathy) and ascites r esistant to conventional therapy in 3 cases. Portovenous pressure coul d be effectively reduced by mean of 37%. Within a mean observation per iod of 8 months 13 patients including the emergency cases remained wit hout recurrent bleeding. Duplexsonography showed patent stents 1 patie nt suffered from an early recurrent bleeding due to occlusion of th st ent-shunt. The estimation of liver function according to the Child-Pug h-classification showed only minor changes. Before TIPS 9 patients wer e in class A 4 in B, 2 in C; after TIPS 8 patients in A, 5 in B and 2 in C. Ascites resolved completely. Following TIPS all patients appeare d to abstain from alcohol. After TIPS 5 from 14 surviving patients (50 %) developed clinically manifest encephalopathy within the first 4-8 w eeks (2 patients with previous episodes of encephalopathy, 2 other pat ients after withdrawal of lactulose). Be enhanced conservative treatme nt (laetulose, paromomycine and protein restriction) encephalopathy co uld be overcome 8 from 11 surviving patients investigated displayed ch aracteristic MRI changes with an increased signal intensity in the bas al ganglia (T1 weighted images). According to our preliminary results TIPS represents a new successful interventional regimen for the treatm ent of portal hypertension in selected cases.