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Review
. 2024 Sep 24;13(19):5681.
doi: 10.3390/jcm13195681.

Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Treatment of Bleeding from Cardiofundal and Ectopic Varices in Cirrhosis

Sarah Shalaby  1   2 , Oana Nicoară-Farcău  1   3 , Valeria Perez-Campuzano  1   2 , Pol Olivas  1   2 , Sonia Torres  1   2 , Juan Carlos García-Pagán  1   2   4 , Virginia Hernández-Gea  1   2   4
Affiliations
Review

Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Treatment of Bleeding from Cardiofundal and Ectopic Varices in Cirrhosis

Sarah Shalaby et al. J Clin Med. .

Abstract

Acute variceal bleeding in cirrhosis represents a critical clinical event that significantly impacts patient prognosis, with mortality rates increasing further after a second episode. This underscores the need for immediate intervention and optimal prophylaxis. The creation of a transjugular intrahepatic portosystemic shunt (TIPS) has been proven to be highly effective for managing esophageal variceal bleeding. However, the use of TIPS for managing cardiofundal gastric varices and ectopic varices remains debated due to their unique vascular anatomy and the limited data available. These varices, although less prevalent than esophageal varices, are complex and heterogeneous vascular shunts between the splanchnic venous system and the systemic veins. Indeed, while endoscopic therapy with tissue adhesives is widely endorsed for achieving hemostasis in active hemorrhage, there is no consensus regarding the optimal approach for secondary prophylaxis. Recent research emphasizes the efficacy of endovascular techniques over endoscopic treatments, such as TIPS and endovascular variceal embolization techniques. This review examines the use of TIPS in managing acute variceal bleeding in patients with cirrhosis, focusing specifically on cardiofundal gastric varices and ectopic varices, discussing optimal patient care based on the latest evidence, aiming to improve outcomes for this challenging subset of patients.

Keywords: gastric varices; portal-hypertensive hemorrhage; portosystemic shunt; secondary prophylaxis; variceal embolization.

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Conflict of interest statement

JCGP and VHG receive speaker fees from GORE medical and COOK medical.

Figures

Figure 1
Figure 1
Endoscopic classification of gastric varices according to Sarin Classification. Gastroesophageal varices type 1 (GOV1), gastroesophageal varices type 2 (GOV2), isolated gastric varices type 1 (IGV1), isolated gastric varices type 2 (IGV2), and duodenal varices. Created with Biorender.com.
Figure 2
Figure 2
Algorithm summarizing current recommendations for secondary prophylaxis for esophageal varices and GOV1. Created with Biorender.com.
Figure 3
Figure 3
Left panel: Example of TIPS placement for bleeding from cardiofundal GV, showing previous treatment with cyanoacrylate (arrow). Right panel: Example of TIPS placement for bleeding from cardiofundal GV with concomitant antegrade embolization of the varix (arrow). Created with Biorender.com.
Figure 4
Figure 4
Algorithm summarizing current recommendations for secondary prophylaxis for cardiofundal GV. Created with Biorender.com.
See this image and copyright information in PMC

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