Role of Tips in Acute Variceal Bleeding
Huerta, Anna (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
García-Guix, Marta (Hospital Universitari de Bellvitge)
Villanueva, Càndid (Universitat Autònoma de Barcelona. Departament de Medicina)

Date:	2025
Abstract:	Purpose of review: We aimed to review the role of TIPS in acute variceal bleeding (AVB), focusing on preemptive-TIPS (p-TIPS) as discrepant data suggest room for refinement. Recent findings: Salvage-TIPS can effectively control ongoing AVB despite first-line therapy, but mortality is high. Placing a p-TIPS to prevent failure in high-risk patients may improve survival. This is related to its effect decreasing the overall risk of a further decompensation (FD), not just rebleeding but also ascites and derived complications. Summary: FD is closely related to death risk after AVB. The risk of FD and death concentrates in patients presenting with ascites ± HE in addition to AVB. p-TIPS improve survival, not only by decreasing rebleeding risk, but mainly FD overall. This review suggests potential improvements to optimize p-TIPS, such as improving risk stratification, restricting the indication to patients with AVB and ascites ± HE, or selectively identifying those at high-risk of failure (10%-15% cases) for an early placement. Research on these issues is warranted.
Grants:	Ministerio de Economía y Competitividad PI14/00876 Ministerio de Economía y Competitividad PI15/00066
Note:	Altres ajuts: acords transformatius de la UAB
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Subject:	Acute variceal bleeding ; Salvage TIPS ; Preemptive TIPS ; Elective TIPS ; Decompensated cirrhosis ; Further decompensation ; Stages of cirrhosis
Published in:	Current Hepatology Reports, Vol. 24 Núm. 1 (July 2025) , ISSN 2195-9595

DOI: 10.1007/s11901-025-00694-7

17 p, 822.2 KB

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