Role of Tips in Acute Variceal Bleeding

Abstract

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.