PORTAL HEMODYNAMICS, LIVER-FUNCTION AND C LINICAL FOLLOW-UP AFTER TIPS

In 126 patients with liver cirrhosis treated electively with transjugu lar intrahepatic portosystemic stent shunt (TIPS) to prevent variceal rebleeding, the portosystemic pressure gradient decreased by 60 %. In spite of this incomplete effect the risk for variceal rebleeding was s till under 20 % after 2 years. Only 1 patient died of variceal rebleed ing. Shunt insufficiency occurred in 50 %, mainly during the first yea r, but shunt function was restored in nearly all cases by radiologic i ntervention, i.e., redilatation or implantation of an additional stent . During the follow-up of 16 +/- 9 months, 21 patients (17 %) died, on e-third of them from progressive liver failure aggravated in 4 cases b y severe drinking. De novo hepatic encephalopathy was observed in 10 % , especially in older patients and patients with impaired liver functi on before TIPS. In such patients it is recommended that the shunt be d ilated to 0.8 cm at most, and the TIPS procedure can be combined with transjugular embolization of the varices. The advantages of TIPS over both endoscopic sclerotherapy and drug treatment must be clarified in randomized studies, which have already been initiated in several cente rs.