Role of Tips in Acute Variceal Bleeding
Purpose of review: We aimed to review the role of TIPS in acute variceal bleeding (AVB), focusing on preemptive-TIPS (p-TIPS) as discrepant data suggest room for refinement. Recent findings: Salvage-TIPS can effectively control ongoing AVB despite first-line therapy, but mortality is high. Placing a...
| Autores: | , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:318758 |
| Acceso en línea: | https://ddd.uab.cat/record/318758 https://dx.doi.org/urn:doi:10.1007/s11901-025-00694-7 |
| Access Level: | acceso abierto |
| Palabra clave: | Acute variceal bleeding Salvage TIPS Preemptive TIPS Elective TIPS Decompensated cirrhosis Further decompensation Stages of cirrhosis |
| Sumario: | Purpose of review: We aimed to review the role of TIPS in acute variceal bleeding (AVB), focusing on preemptive-TIPS (p-TIPS) as discrepant data suggest room for refinement. Recent findings: Salvage-TIPS can effectively control ongoing AVB despite first-line therapy, but mortality is high. Placing a p-TIPS to prevent failure in high-risk patients may improve survival. This is related to its effect decreasing the overall risk of a further decompensation (FD), not just rebleeding but also ascites and derived complications. Summary: FD is closely related to death risk after AVB. The risk of FD and death concentrates in patients presenting with ascites ± HE in addition to AVB. p-TIPS improve survival, not only by decreasing rebleeding risk, but mainly FD overall. This review suggests potential improvements to optimize p-TIPS, such as improving risk stratification, restricting the indication to patients with AVB and ascites ± HE, or selectively identifying those at high-risk of failure (10%-15% cases) for an early placement. Research on these issues is warranted. |
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