THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEM IC SHUNT - INDICATIONS AND RESULTS

The use of the transjugular intrahepatic portosystemic shunt (TIPS) an d its indication for treatment of the various symptoms of portal hyper tension is still under debate. This paper presents guidlines for its a pplication based on randomized studies, case reports, and own experien ce. TIPS is indicated in acute variceal bleeding not responding to end oscopic treatment and medication. In this emergency situation TIPS has probably a lower early mortality rate than surgical shunts. The proph ylactic treatment of first variceal bleeding is a domaine for medical therapy. Due to its increased incidence of hepatic encephalopathy TIPS mali only be indicated in very selected cases with a high risk of ble eding and associated severe complications. Five randomized trials incl uding 402 patients exist comparing endoscopic treatment and TIPS. Exep t one study the results are conclusive demonstrating comparable surviv al of the groups. Despite these results, in view of the high rate of s hunt-induced encephalopathy with its negative effect on life quality, TIPS may better be a secondary treatment as long as studies on life qu ality are lacking. However, in many patients additional complications, e. g. accompanying ascites or intolerance to bleedings, may justify t he primary use of TIPS. TIPS is also effective in the treatment of ref ractory ascites. Conclusive randomized studies are not available, ther efore, TIPS should be restricted to patients who are intolerant to or who fail paracentesis. In addition to the leading indications mentione d, rare indications for TIPS and the role of surgical shunts are discu ssed.