The insertion of a transjugular intrahepatic portasystemic
stent shunt (
TIPSS) was evaluated in 22 patients with recurrent upper gastrointestinal haemorrhage related to
portal hypertension (
bleeding from oesophageal
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 were 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 earlier patients that have not recurred after modification of the initial technique.
TIPSS can be life saving and is effective in controlling variceal haemorrhage and rebleeding from oesophageal or
gastric varices and portal hypertensive gastropathy. Larger and longer term studies are required, however, to define the role of
TIPSS in the overall management of such patients.