Tie J, Yuan XL, Niu J, Xu J, Shi YQ. Transjugular intrahepatic portosystemic shunt combined with viral suppression reverses decompensated cirrhosis: Two case reports. World J Gastroenterol 2026; 32(37): 120860 [DOI: 10.3748/wjg.120860]
Corresponding Author of This Article
Jun Tie, MD, PhD, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, No. 127 Changle West Road, Xi’an 710032, Shaanxi Province, China. tiejun7776@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
case-report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 7, 2026; 32(37): 120860 Published online Oct 7, 2026. doi: 10.3748/wjg.120860
Transjugular intrahepatic portosystemic shunt combined with viral suppression reverses decompensated cirrhosis: Two case reports
Jun Tie, Xu-Long Yuan, Jing Niu, Jiao Xu, Yong-Quan Shi
Jun Tie, Xu-Long Yuan, Jing Niu, Jiao Xu, Yong-Quan Shi, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
Author contributions: Tie J and Yuan XL performed the transjugular intrahepatic portosystemic shunt procedure; Tie J, Yuan XL, and Shi YQ were involved in patient management; Tie J drafted the manuscript and serves as the study guarantor; Niu J and Xu J collected the clinical data; All authors thoroughly reviewed and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the participants for publication of the case details and accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jun Tie, MD, PhD, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, No. 127 Changle West Road, Xi’an 710032, Shaanxi Province, China. tiejun7776@163.com
Received: March 11, 2026 Revised: April 1, 2026 Accepted: May 6, 2026 Published online: October 7, 2026 Processing time: 174 Days and 18.9 Hours
Abstract
BACKGROUND
Decompensated cirrhosis, particularly when complicated by portal hypertension, has traditionally been regarded as an irreversible condition with a progressive clinical course.
CASE SUMMARY
We present 2 male patients (aged 43 and 50) with chronic hepatitis B and hepatitis C, respectively. Both patients had confirmed decompensated cirrhosis and significant splenomegaly, and were admitted for acute variceal hemorrhage refractory to endoscopic variceal ligation. Each underwent successful transjugular intrahepatic portosystemic shunt (TIPS) creation using a covered stent, which led to an immediate and substantial reduction in the portosystemic pressure gradient. While the second patient required shunt revision at 6 months due to stent stenosis, both were followed for over a decade. During this period, neither experienced recurrence of variceal bleeding, ascites, or hepatic encephalopathy. Liver function improved from Child-Pugh class B to A, viral loads remained undetectable under antiviral therapy, and spleen size regressed progressively. Remarkably, even after eventual TIPS occlusion in one case, the portosystemic pressure gradient remained within the normal range, and angiography revealed no visible esophageal varices. Sequential liver biopsies demonstrated significant regression of hepatic fibrosis and the disappearance of cirrhotic architecture, indicating substantial fibrosis regression.
CONCLUSION
This report suggests that in carefully selected patients, the combination of TIPS and effective etiological control can facilitate the long-term reversal of portal hypertension and promote histological regression of cirrhosis itself.
Core Tip: This case series demonstrates that decompensated cirrhosis—long thought to irreversible—can be clinically and histologically reversed. The key is combining transjugular intrahepatic portosystemic shunt to alleviate portal hypertension with sustained antiviral therapy to control the underlying etiology.
