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 an 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 may only be indicated in very selected cases with a high risk of blee ding and associated severe complications. Fire randomized trials inclu ding 402 patients exist comparing endoscopic treatment and TIPS. Exept one study the results are conclusive demonstrating comparable surviva l of the groups. Despite these results, in view of the high rate of sh unt-induced encephalopathy with its negative effect on life quality, T IPS may better be a secondary treatment as long as studies on life qua lity are lacking. However, er, in many patients additional complicatio ns: e. g. accompanying: ascites or intolerance to bleedings, may justi fy the primary use of TIPS. TIPS is also effective in the treatment of refractory ascites. Conclusive randomized studies are not available, therefore, TIPS should be restricted to patients who are intolerant to or who fail paracentesis. In addition to the leading indications ment ioned? rare indications for TIPS and the role of surgical shunts are d iscussed.