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Practice Guideline
. 2020 Jul;69(7):1173-1192.
doi: 10.1136/gutjnl-2019-320221. Epub 2020 Feb 29.

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Dhiraj Tripathi  1   2   3 , Adrian J Stanley  4 , Peter C Hayes  5 , Simon Travis  6 , Matthew J Armstrong  7   2   3 , Emmanuel A Tsochatzis  8 , Ian A Rowe  9 , Nicholas Roslund  10 , Hamish Ireland  11 , Mandy Lomax  12 , Joanne A Leithead  13 , Homoyon Mehrzad  14 , Richard J Aspinall  15 , Joanne McDonagh  7 , David Patch  8
Affiliations
Practice Guideline

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Dhiraj Tripathi et al. Gut. 2020 Jul.

Abstract

These guidelines on transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of portal hypertension have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the Liver Section of the BSG. The guidelines are new and have been produced in collaboration with the British Society of Interventional Radiology (BSIR) and British Association of the Study of the Liver (BASL). The guidelines development group comprises elected members of the BSG Liver Section, representation from BASL, a nursing representative and two patient representatives. The quality of evidence and grading of recommendations was appraised using the GRADE system. These guidelines are aimed at healthcare professionals considering referring a patient for a TIPSS. They comprise the following subheadings: indications; patient selection; procedural details; complications; and research agenda. They are not designed to address: the management of the underlying liver disease; the role of TIPSS in children; or complex technical and procedural aspects of TIPSS.

Keywords: ascites; interventional radiology; oesophageal varices; portal hypertension.

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Conflict of interest statement

Competing interests: Dr David Patch: contribution to charity-administered educational fund for teaching purposes (Cook Medical). Dr Dhiraj Tripathi: educational funding (Gore Ltd). Chief investigator of CALIBRE trial investigating non-selective beta-blockers versus variceal band ligation in variceal bleeding (NIHR HTA funding). Member of National Institute of Health and Care Excellence (NICE) Interventional Procedures Advisory Committee (IPAC). Dr Homoyon Mehrzad: speaker fees (Gore Ltd) and educational funding (Gore Ltd). Professor Peter Hayes: speaker fees (Gore Medical). Dr Simon Travis: educational donations for sponsorship to attend scientific meetings and fund courses to train on specific equipment (Abbott Medical, Gore Ltd, Boston Scientific). Dr Richard Aspinall: trustee to charity Liver4Life. Other authors have not declared any conflicts of interest.

Figures

Figure 1
Figure 1
Summary of recommendations for TIPSS in portal hypertensive bleeding. *Further research is required to determine whether patients with Child’s B disease and active bleeding or with MELD 12-18 benefit from pre-emptive TIPSS.
Figure 2
Figure 2
Summary of recommendations for TIPSS in recurrent or refractory ascites.
Figure 3
Figure 3
Summary of recommendations for patient selection prior to TIPSS.
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