Transjugular Intrahepatic Portosystemic Shunt: Challenges and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (20 July 2023) | Viewed by 10355

Special Issue Editors


E-Mail Website
Guest Editor
Department of Translational and Precision Medicine, "Sapienza" University of Rome, Latina, Italy
Interests: portal hypertension; cirrhosis; hepatic encephalopathy; sarcopenia; TIPS
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, “Sapienza” University of Rome, Rome, Italy
Interests: hepatic encephalopathy; minimal hepatic encephalopathy; spontaneous portal-systemic shunts; transjugular intrahepatic portosystemic shunt; cirrhosis; portal hypertension; sarcopenia

E-Mail Website
Guest Editor
Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
Interests: hepatic encephalopathy; minimal hepatic encephalopathy; spontaneous portal-systemic shunts; transjugular intrahepatic portosystemic shunt; cirrhosis; portal hypertension; sarcopenia

Special Issue Information

Dear Colleagues,

Transjugular intrahepatic portosystemic shunts have been part of the therapeutic armamentarium for the resolution of complications related to portal hypertension for years. At first, its use was limited to patients with relapsed esophagogastric variceal hemorrhage or refractory ascites, but over the years, the indications have changed regarding the timing of the procedure, and it has also been extended to other indications, such as congestive transfusion-dependent gastropathy despite standard medical and endoscopic therapy, Budd Chiari syndrome, and portal vein recanalization in the case of portal thrombosis, and it has also been used in selected cases of non-cirrhotic portal hypertension. The aim of this collection will be to provide a systematic and critical analysis of the state of the art, of the gray areas, and of the challenges and the treatment prospects of this procedure.

Dr. Lorenzo Ridola
Dr. Silvia Nardelli
Dr. Stefania Gioia
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hepatic encephalopathy
  • spontaneous portal-systemic shunts
  • transjugular intrahepatic portosystemic shunt
  • cirrhosis
  • portal hypertension
  • sarcopenia
  • myosteatosis
  • gastrointestinal bleeding
  • ascites
  • non cirrhotic portal hypertension

Related Special Issue

Published Papers (8 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

12 pages, 1475 KiB  
Article
Long-Term Efficacy and Safety of Rifaximin in Japanese Patients with Hepatic Encephalopathy: A Multicenter Retrospective Study
by Hideto Kawaratani, Yasuteru Kondo, Ryoji Tatsumi, Naoto Kawabe, Norikazu Tanabe, Akira Sakamaki, Kazuo Okumoto, Yoshihito Uchida, Kei Endo, Takumi Kawaguchi, Tsunekazu Oikawa, Yoji Ishizu, Shuhei Hige, Taro Takami, Shuji Terai, Yoshiyuki Ueno, Satoshi Mochida, Yasuhiro Takikawa, Takuji Torimura, Tomokazu Matsuura, Masatoshi Ishigami, Kazuhiko Koike and Hitoshi Yoshijiadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(6), 1571; https://doi.org/10.3390/jcm11061571 - 12 Mar 2022
Cited by 6 | Viewed by 3369
Abstract
Background: Rifaximin is commonly used for hepatic encephalopathy (HE). However, the effects of long-term treatment for Japanese people are limited. Therefore, this study aimed to investigate the effects and safety of long-term treatment with rifaximin on HE. Methods: A total of 215 patients [...] Read more.
Background: Rifaximin is commonly used for hepatic encephalopathy (HE). However, the effects of long-term treatment for Japanese people are limited. Therefore, this study aimed to investigate the effects and safety of long-term treatment with rifaximin on HE. Methods: A total of 215 patients with cirrhosis administered with rifaximin developed overt or covert HE, which was diagnosed by an attending physician for >12 months. Laboratory data were extracted at pretreatment and 3, 6, and 12 months after rifaximin administration. The long-term effect of rifaximin was evaluated, and the incidence of overt HE during 12 months and adverse events was extracted. Results: Ammonia levels were significantly improved after 3 months of rifaximin administration and were continued until 12 months. There were no serious adverse events after rifaximin administration. The number of overt HE incidents was 9, 14, and 27 patients within 3, 6, and 12 months, respectively. Liver enzymes, renal function, and electrolytes did not change after rifaximin administration. Prothrombin activity is a significant risk factor for the occurrence of overt HE. The serum albumin, prothrombin activity, and albumin–bilirubin (ALBI) scores were statistically improved after 3 and 6 months of rifaximin administration. Moreover, the same results were obtained in patients with Child–Pugh C. Conclusions: The long-term rifaximin treatment was effective and safe for patients with HE, including Child–Pugh C. Full article
Show Figures

Figure 1

Review

Jump to: Research

11 pages, 530 KiB  
Review
Transjugular Intrahepatic Portosystemic Shunt as a Bridge to Abdominal Surgery in Cirrhosis
by Fabio Melandro, Simona Parisse, Stefano Ginanni Corradini, Vincenzo Cardinale, Flaminia Ferri, Manuela Merli, Domenico Alvaro, Francesco Pugliese, Massimo Rossi, Gianluca Mennini and Quirino Lai
J. Clin. Med. 2024, 13(8), 2213; https://doi.org/10.3390/jcm13082213 - 11 Apr 2024
Viewed by 591
Abstract
Abdominal surgery is associated with high postoperative mortality and morbidity in cirrhotic patients. Despite improvements in surgical techniques, clinical management, and intensive care, the outcome could be influenced by the degree of portal hypertension, the severity of hepatopathy, or the type of surgery. [...] Read more.
Abdominal surgery is associated with high postoperative mortality and morbidity in cirrhotic patients. Despite improvements in surgical techniques, clinical management, and intensive care, the outcome could be influenced by the degree of portal hypertension, the severity of hepatopathy, or the type of surgery. Preoperative transjugular intrahepatic portosystemic shunt (TIPS) placement, in addition to medical therapy, plays an important role in managing the complications of portal hypertension such as ascites, hepatic encephalopathy, variceal bleeding or portal vein thrombosis. To date, the improvement of post-surgery outcomes in cirrhotic patients after TIPS placement remains unclear. Only observational data existing in the literature and prospective studies are urgently needed to evaluate the efficacy and safety of TIPS in this setting. This review aims to outline the role of TIPS as a tool in postoperative complications reduction in cirrhotic patients, both in the setting of emergency and elective surgery. Full article
Show Figures

Graphical abstract

16 pages, 1275 KiB  
Review
Transjugular Intrahepatic Portosystemic Shunt in Nonmalignant Noncirrhotic Portal Vein Thrombosis and Portosinusoidal Vascular Disorder
by Sarah Shalaby, Roberto Miraglia and Marco Senzolo
J. Clin. Med. 2024, 13(5), 1412; https://doi.org/10.3390/jcm13051412 - 29 Feb 2024
Viewed by 615
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) emerges as a key treatment for portal hypertension (PH) complications. While international guidelines provide clear indications for its use in cirrhosis, empirical knowledge is notably scarcer in non-cirrhotic PH, particularly in nonmalignant noncirrhotic portal vein thrombosis (NNPVT) and [...] Read more.
Transjugular intrahepatic portosystemic shunt (TIPS) emerges as a key treatment for portal hypertension (PH) complications. While international guidelines provide clear indications for its use in cirrhosis, empirical knowledge is notably scarcer in non-cirrhotic PH, particularly in nonmalignant noncirrhotic portal vein thrombosis (NNPVT) and in patients with portosinusoidal vascular disorder (PSVD). Patients afflicted by these rare diseases exhibit distinct clinical profiles compared to their cirrhotic counterparts, often characterized by a younger age, predominantly preserved hepatic functionality even in cases of severe PH, and a higher propensity for extensive splanchnic thrombosis, which intricately complicates TIPS placement, posing unique challenges for its creation. The objective of this review is to synthesize existing literature on the effectiveness, safety, specific indications, and clinical outcomes of TIPS in adult patients with NNPVT or PSVD, focusing also on the technical challenges of TIPS insertion in the presence of portal cavernoma. Full article
Show Figures

Figure 1

12 pages, 1382 KiB  
Review
The Role of Transjugular Intrahepatic Portosystemic Shunt for the Management of Ascites in Patients with Decompensated Cirrhosis
by Giulia Iannone, Enrico Pompili, Clara De Venuto, Dario Pratelli, Greta Tedesco, Maurizio Baldassarre, Paolo Caraceni and Giacomo Zaccherini
J. Clin. Med. 2024, 13(5), 1349; https://doi.org/10.3390/jcm13051349 - 27 Feb 2024
Viewed by 841
Abstract
The development and progression of ascites represent a crucial event in the natural history of patients with cirrhosis, predisposing them to other complications and carrying a heavy impact on prognosis. The current standard of care for the management of ascites relies on various [...] Read more.
The development and progression of ascites represent a crucial event in the natural history of patients with cirrhosis, predisposing them to other complications and carrying a heavy impact on prognosis. The current standard of care for the management of ascites relies on various combinations of diuretics and large-volume paracenteses. Periodic long-term albumin infusions on top of diuretics have been recently shown to greatly facilitate the management of ascites. The insertion of a transjugular intrahepatic portosystemic shunt (TIPS), an artificial connection between the portal and caval systems, is indicated to treat patients with refractory ascites. TIPS acts to decrease portal hypertension, thus targeting an upstream event in the pathophysiological cascade of cirrhosis decompensation. Available evidence shows a significant benefit on ascites control/resolution, with less clear results on patient survival. Patient selection plays a crucial role in obtaining better clinical responses and avoiding TIPS-related adverse events, the most important of which are hepatic encephalopathy, cardiac overload and failure, and liver failure. At the same time, some recent technical evolutions of available stents appear promising but deserve further investigations. Future challenges and perspectives include (i) identifying the features for selecting the ideal candidate to TIPS; (ii) recognizing the better timing for TIPS placement; and (iii) understanding the most appropriate role of TIPS within the framework of all other available treatments for the management of patients with decompensated cirrhosis. Full article
Show Figures

Figure 1

14 pages, 1320 KiB  
Review
Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting
by Simone Di Cola, Lucia Lapenna, Jakub Gazda, Stefano Fonte, Giulia Cusi, Samuele Esposito, Marco Mattana and Manuela Merli
J. Clin. Med. 2024, 13(2), 600; https://doi.org/10.3390/jcm13020600 - 21 Jan 2024
Cited by 1 | Viewed by 1066
Abstract
Liver transplantation is currently the only curative therapy for patients with liver cirrhosis. Not all patients in the natural course of the disease will undergo transplantation, but the majority of them will experience portal hypertension and its complications. In addition to medical and [...] Read more.
Liver transplantation is currently the only curative therapy for patients with liver cirrhosis. Not all patients in the natural course of the disease will undergo transplantation, but the majority of them will experience portal hypertension and its complications. In addition to medical and endoscopic therapy, a key role in managing these complications is played by the placement of a transjugular intrahepatic portosystemic shunt (TIPS). Some indications for TIPS placement are well-established, and they are expanding and broadening over time. This review aims to describe the role of TIPS in managing patients with liver cirrhosis, in light of liver transplantation. As far as it is known, TIPS placement seems not to affect the surgical aspects of liver transplantation, in terms of intraoperative bleeding rates, postoperative complications, or length of stay in the Intensive Care Unit. However, the placement of a TIPS “towards transplant” can offer advantages in terms of ameliorating a patient’s clinical condition at the time of transplantation and improving patient survival. Additionally, the TIPS procedure can help preserve the technical feasibility of the transplant itself. In this context, indications for TIPS placement at an earlier stage are drawing particular attention. However, TIPS insertion in decompensated patients can also lead to serious adverse events. For these reasons, further studies are needed to make reliable recommendations for TIPS in the pre-transplant setting. Full article
Show Figures

Figure 1

18 pages, 1702 KiB  
Review
Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy—A Review of the Past Decade’s Literature Focusing on Incidence, Risk Factors, and Prophylaxis
by Karina Holm Friis, Karen Louise Thomsen, Wim Laleman, Sara Montagnese, Hendrik Vilstrup and Mette Munk Lauridsen
J. Clin. Med. 2024, 13(1), 14; https://doi.org/10.3390/jcm13010014 - 19 Dec 2023
Viewed by 1368
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension and its’ complications in liver cirrhosis, yet the development of hepatic encephalopathy (HE) remains a significant concern. This review covers the reported incidence, risk factors, and management strategies for post-TIPS HE [...] Read more.
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension and its’ complications in liver cirrhosis, yet the development of hepatic encephalopathy (HE) remains a significant concern. This review covers the reported incidence, risk factors, and management strategies for post-TIPS HE over the past decade. Incidence varies widely (7–61%), with factors like age, liver function, hyponatremia, and spontaneous portosystemic shunts influencing risk. Procedural aspects, including TIPS timing, indication, and stent characteristics, also contribute. Pharmacological prophylaxis with lactulose and rifaximin shows promise, but current evidence is inconclusive. Procedural preventive measures, such as shunt embolization and monitoring portal pressure gradients, are explored. Treatment involves pharmacological options like lactulose and rifaximin, and procedural interventions like stent diameter reduction. Ongoing studies on novel predictive markers and emerging treatments, such as faecal microbiota transplant, reflect the evolving landscape in post-TIPS HE management. This concise review provides clinicians with insights into the multifaceted nature of post-TIPS HE, aiding in improved risk assessment, prophylaxis, and management for patients undergoing TIPS procedures. Full article
Show Figures

Figure 1

12 pages, 795 KiB  
Review
Transjugular Intrahepatic Portosystemic Shunt Placement: Effects on Nutritional Status in Cirrhotic Patients
by Ilaria de Felice, Lorenzo Ridola, Oliviero Riggio, Jessica Faccioli, Silvia Nardelli and Stefania Gioia
J. Clin. Med. 2023, 12(22), 7029; https://doi.org/10.3390/jcm12227029 - 10 Nov 2023
Cited by 2 | Viewed by 893
Abstract
Malnutrition is a tangible complication of cirrhosis with portal hypertension with a prevalence of up to 50%. In particular, sarcopenia and myosteatosis, defined as the alteration in muscle quantity and quality, have a negative impact on the main complications of liver disease and [...] Read more.
Malnutrition is a tangible complication of cirrhosis with portal hypertension with a prevalence of up to 50%. In particular, sarcopenia and myosteatosis, defined as the alteration in muscle quantity and quality, have a negative impact on the main complications of liver disease and are associated with higher mortality in patients with cirrhosis. Recently, alterations in adipose tissue have also been described in cirrhotic patients and they seem to influence the course of liver disease. Several pieces of evidence indicate that a transjugular intrahepatic portosystemic shunt (TIPS), placed for the treatment of refractory portal hypertension, can lead to a modification of body composition consisting in the improvement of the skeletal muscle index, myosteatosis, and an increase in subcutaneous fat. These modifications of the nutritional status, even more pronounced in sarcopenic patients before TIPS, have been associated with an amelioration of cognitive impairment after TIPS as well as with an increase in the survival rate. The aim of this paper is to provide an overview of the effects of TIPS placement on nutritional status in cirrhosis focusing on its pathophysiological mechanisms and its relationship with liver-related outcomes. Full article
Show Figures

Figure 1

17 pages, 1697 KiB  
Review
Transjugular Intrahepatic Portosystemic Shunt: Devices Evolution, Technical Tips and Future Perspectives
by Dario Saltini, Federica Indulti, Tomas Guasconi, Marcello Bianchini, Biagio Cuffari, Cristian Caporali, Federico Casari, Francesco Prampolini, Marco Senzolo, Antonio Colecchia and Filippo Schepis
J. Clin. Med. 2023, 12(21), 6758; https://doi.org/10.3390/jcm12216758 - 25 Oct 2023
Cited by 1 | Viewed by 1152
Abstract
Portal hypertension (PH) constitutes a pivotal factor in the progression of cirrhosis, giving rise to severe complications and a diminished survival rate. The transjugular intrahepatic portosystemic shunt (TIPS) procedure has undergone significant evolution, with advancements in stent technology assuming a central role in [...] Read more.
Portal hypertension (PH) constitutes a pivotal factor in the progression of cirrhosis, giving rise to severe complications and a diminished survival rate. The transjugular intrahepatic portosystemic shunt (TIPS) procedure has undergone significant evolution, with advancements in stent technology assuming a central role in managing PH-related complications. This review aims to outline the progression of TIPS and emphasizes the significant influence of stent advancement on its effectiveness. Initially, the use of bare metal stents (BMSs) was limited due to frequent dysfunction. However, the advent of expanding polytetrafluoroethylene-covered stent grafts (ePTFE-SGs) heralded a transformative era, greatly enhancing patency rates. Further innovation culminated in the creation of ePTFE-SGs with controlled expansion, enabling precise adjustment of TIPS diameters. Comparative analyses demonstrated the superiority of ePTFE-SGs over BMSs, resulting in improved patency, fewer complications, and higher survival rates. Additional technical findings highlight the importance of central stent placement and adequate stent length, as well as the use of smaller calibers to reduce the risk of shunt-related complications. However, improving TIPS through technical means alone is inadequate for optimizing patient outcomes. An extensive understanding of hemodynamic, cardiac, and systemic factors is required to predict outcomes and tailor a personalized approach. Looking forward, the ongoing progress in SG technology, paired with the control of clinical factors that can impact outcomes, holds the promise of reshaping the management of PH-related complications in cirrhosis. Full article
Show Figures

Graphical abstract

Back to TopTop