TIPS: Primary therapy or rescue in treatment of acute variceal hemorrhage

Abstract

Variceal bleeding is a severe complication of portal hypertension in which TIPS has shown a clear benefit. Despite its use in the setting of uncontrolled acute variceal bleeding its use has evolved to more refined indications aimed to prevent treatment failure and rebleeding. Early placement of TIPS in selected patients with a high risk of treatment failure has recently demonstrated to improve survival without adding morbidity. HVPG ≥20 mmHg, Child Pugh B score plus active bleeding at diagnostic endoscopy, and Child Pugh C have been postulated as high-risk criteria able to select a population that may benefit from early TIPS. In the setting of gastric varices bleeding the role of TIPS needs to be better characterized and nowadays remains as a rescue treatment. A better stratification of patients who may benefit from early TIPS may improve acute variceal bleeding and outcome.