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Review
. 2022 Dec 28;10(6):1223-1228.
doi: 10.14218/JCTH.2022.00240. Epub 2022 Jul 29.

Pre-emptive TIPSS in Acute Variceal Bleeding: Current Status, Controversies, and Future Directions

Yu Jun Wong  1   2 , Wei Ling Danielle Ho  1 , Juan G Abraldes  3
Affiliations
Review

Pre-emptive TIPSS in Acute Variceal Bleeding: Current Status, Controversies, and Future Directions

Yu Jun Wong et al. J Clin Transl Hepatol. .

Abstract

Acute variceal bleeding (AVB) is associated with significant short-term morbidity and mortality. Pre-emptive transjugular intrahepatic portosystemic shunt (p-TIPSS) is recommended to prevent rebleeding in AVB patients with a high risk of rebleeding. Despite the benefit of preventing rebleeding and de-novo ascites, the uptake of p-TIPSS remains low because logistic challenges in the real-world setting. In this review, we summarize the current evidence and controversies on p-TIPSS including patient selection for p-TIPSS, particularly in the setting of NASH cirrhosis and acute-on-chronic liver failure, the role of sarcopenia, renal impairment in the setting of p-TIPSS. Finally, we summarize both pharmacological and nonpharmacological strategies to optimize outcomes in patients undergoing p-TIPSS.

Keywords: Cirrhosis; Hemorrhage; Portal hypertension; Transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

YJW has been an editorial board member of Journal of Clinical and Translational Hepatology since 2020. The authors have no conflict of interests related to this publication.

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