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Am Fam Physician. 1998;57(9):2227-2228

Treatment options for acute or recurrent hemorrhage secondary to esophageal varices now include the transjugular intrahepatic portosystemic shunt (TIPS) procedure. TIPS provides physicians with a treatment option other than surgery during acute bleeding episodes. Sahagun and associates observed 100 consecutive patients who had TIPS performed for acute or recurrent esophageal variceal hemorrhage, and who were refractory to medical management and had advanced liver disease.

Patients were studied prospectively after the TIPS procedure to evaluate recurrent hemorrhages, survival rates, indicators for hepatic decompensation, short- and long-term shunt patency and complications.

Study results showed that the procedure did reduce portal pressures. Ten complications, including pulmonary edema, hepatic arterial injury and sepsis, and one death associated with the procedure were reported. The cumulative survival rate was 85 percent at 30 days, 71 percent at one year and 54 percent at two years. Recurrent hemorrhage occurred in 20 percent of patients at one year and in 25 percent at two years. Clinical parameters demonstrated an improvement in the patients with ascites, but hepatic encephalopathy also increased. Forty-seven percent of the patients needed intervention during the study to maintain shunt patency.

The authors conclude that TIPS provides an alternative procedure in patients with acute or recurrent esophageal varices and avoids the risks associated with surgical intervention. If performed appropriately, TIPS can reduce the risk of hemorrhage from varices while having no impact on the patient's eligibility for liver transplant.

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