TRANSJUGULAR INTRAHEPATIC PORTASYSTEMIC STENT SHUNTING FOR CONTROL OFACUTE AND RECURRENT UPPER GASTROINTESTINAL HEMORRHAGE RELATED TO PORTAL-HYPERTENSION

The insertion of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was evaluated in 22 patients with recurrent upper gastrointes tinal haemorrhage related to portal hypertension (bleeding from oesoph ageal varices 10, gastric varices six, portal hypertensive gastropathy six). TIPSS was successfully performed electively in 15 patients and as an emergency in three patients. Twelve patients have had no further admissions with bleeding after TIPSS. Single episodes of bleeding wer e noted in six patients after TIPSS associated with shunt thrombosis ( two), intimal hyperplasia within the shunt (two), and shunt migration (one). Another patient presented with reaccumulated ascites suggesting poor shunt function but died from massive variceal haemorrhage before further assessment could be performed. There was one death related to the procedure. Two patients developed encephalopathy after TIPSS, in one patient this was controlled by the insertion of a smaller diameter stent within the existing TIPSS. Several complications arose in earli er patients that have not recurred after modification of the initial t echnique. TIPSS can be life saving and is effective in controlling var iceal haemorrhage and rebleeding from oesophageal or gastric varices a nd portal hypertensive gastropathy. Larger and longer term studies are required, however, to define the role of TIPSS in the overall managem ent of such patients.