Patient Selection for Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion in Variceal Bleeding and Refractory Ascites

Abstract

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is used to treat the complications of portal hypertension. Patient selection prior to TIPSS remains paramount for survival. This review aims to summarise the key clinical steps in patient selection prior to TIPSS and how patient selection has evolved over the last 5 years. Model for End-Stage Liver Disease (MELD) and Child-Pugh scoring in combination remain good predictors of clinical outcome post TIPSS. Minimal hepatic encephalopathy remains a diagnostic challenge, and further testing should be implemented in elective assessment. Portal vein thrombosis is no longer an absolute contraindication. The importance of diastolic dysfunction pre TIPSS remains controversial, and at present echocardiography is only recommended in patients with preexisting cardiac disease, cardiac symptoms and/or incidental abnormal ECG. A combination of MELD, Child-Pugh, age, encephalopathy and liver imaging remain key in assessing risk pre TIPSS. A multidisciplinary team approach should be adopted for patient selection.