LONG-TERM FOLLOW-UP OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT (TIPSS) FOR THE TREATMENT OF PORTAL-HYPERTENSION - RESULTS IN 130 PATIENTS

Background-Transjugular intrahepatic portosystemic stent shunts (TIPSS ) are increasingly being used to manage the complications of portal hy pertension. This study reports on the follow up on 130 patients who ha ve undergone TIPSS. Patients and Methods-One hundred and thirty patien ts (81 male), mean (SD) age 54.7 (12.5) years underwent TIPSS. The maj ority (64.6%) had alcoholic cirrhosis and 53.2% had Childs C disease. Indications were: variceal haemorrhage (76.2%), refractory ascites (13 .1%), portal hypertensive gastropathy (4.6%), others (6.1%). Shunt fun ction was assessed by Doppler ultrasonography and two then six monthly portography and mean follow up for survivors was 18.0 months (range 2 -43.5). Results-The procedure was successful in 119 (91.5%). Sixty thr ee episodes of shunt dysfunction were observed in 45 (37.8%) patients. Variceal rebleeding occurred in 16 (13.4%) patients and was always as sociated with shunt dysfunction. Twenty (16.8%) patients had new or wo rse spontaneous encephalopathy after TIPSS and 11 (64.7%) patients had an improvement in resistant ascites. Thirty day mortality was 21.8% a nd one year survival 62.5%. Conclusion-TIPSS is an effective treatment for variceal bleeding, resistant ascites, and portal hypertensive gas tropathy. Rebleeding is invariably associated with shunt dysfunction, the frequency of which increases with time, therefore regular and long term shunt surveillance is required.