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• W3217503820 startingPage "7612" @default.
• W3217503820 abstract "Variceal bleeding is a serious complication of cirrhosis and portal hypertension. Despite the improvement in management of acute variceal bleed (AVB), it still carries significant mortality. Portal pressure is the main driver of variceal bleeding and also a main predictor of decompensation. Reduction in portal pressure has been the mainstay of management of variceal bleeding. Transjugular intrahepatic porto-systemic stent shunt (TIPSS) is a very effective modality in reducing the portal hypertension and thereby, controlling portal hypertensive bleeding. However, its use in refractory bleeding (rescue/salvage TIPSS) is still associated with high mortality. Early use of TIPSS as a pre-emptive strategy in patients with AVB at high risk of failure of treatment has shown to be superior to standard treatment in several studies. While patients with Child C cirrhosis (up to 13 points) clearly benefit from early-TIPSS strategy, it's role in less severe liver disease (Child B) and more severe disease (Child C > 13 points) remains less clear. Moreover, standard of care has improved in the last decade leading to improved 1-year survival in high-risk patients with AVB as compared to earlier early TIPSS studies. Lastly in the real world, only a minority of patients with AVB fulfil the stringent criteria for early TIPSS. Therefore, there is unmet need to explore role of early TIPSS in management of AVB in well-designed prospective studies. In this review, we have appraised the role of early TIPSS, patient selection and discussed future directions in the management of patients with AVB." @default.
• W3217503820 created "2021-12-06" @default.
• W3217503820 creator A5006656921 @default.
• W3217503820 creator A5050794885 @default.
• W3217503820 date "2021-11-28" @default.
• W3217503820 modified "2023-09-26" @default.
• W3217503820 title "Role of early transjugular intrahepatic portosystemic stent-shunt in acute variceal bleeding: An update of the evidence and future directions" @default.
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• W3217503820 doi "https://doi.org/10.3748/wjg.v27.i44.7612" @default.
• W3217503820 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/34908802" @default.
• W3217503820 hasPublicationYear "2021" @default.
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