Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2024; 16(6): 891-899
Published online Jun 27, 2024. doi: 10.4254/wjh.v16.i6.891
Milestones to optimize of transjugular intrahepatic portosystemic shunt technique as a method for the treatment of portal hypertension complications
Dmitry Victorovich Garbuzenko
Dmitry Victorovich Garbuzenko, Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
Author contributions: Garbuzenko DV contributed to the conception, design, acquisition, analysis, interpretation of data, wrote the manuscript and approved the final version.
Conflict-of-interest statement: Author has no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dmitry Victorovich Garbuzenko, DSc, MD, PhD, Professor, Department of Faculty Surgery, South Ural State Medical University, 64 Vorovskogo Street, Chelyabinsk 454092, Russia. garb@inbox.ru
Received: April 7, 2024
Revised: May 10, 2024
Accepted: May 20, 2024
Published online: June 27, 2024
Processing time: 73 Days and 18.9 Hours
Abstract

This editorial describes the milestones to optimize of transjugular intrahepatic portosystemic shunt (TIPS) technique, which have made it one of the main methods for the treatment of portal hypertension complications worldwide. Innovative ideas, subsequent experimental studies and preliminary experience of use in cirrhotic patients contributed to the introduction of TIPS into clinical practice. At the moment, the main achievement in optimize of TIPS technique is progress in the qualitative characteristics of stents. The transition from bare metal stents to extended polytetrafluoroethylene–covered stent grafts made it possible to significantly prevent shunt dysfunction. However, the question of its preferred diameter, which contributes to an optimal reduction of portal pressure without the risk of developing post-TIPS hepatic encephalopathy, remains relevant. Currently, hepatic encephalopathy is one of the most common complications of TIPS, significantly affecting its effectiveness and prognosis. Careful selection of patients based on cognitive indicators, nutritional status, assessment of liver function, etc., will reduce the incidence of post-TIPS hepatic encephalopathy and improve treatment results. Optimize of TIPS technique has significantly expanded the indications for its use and made it one of the main methods for the treatment of portal hypertension complications. At the same time, there are a number of limitations and unresolved issues that require further randomized controlled trials involving a large cohort of patients.

Keywords: Liver cirrhosis; Portal hypertension; Gastroesophageal variceal bleeding; Prevention; Management; Transjugular intrahepatic portosystemic shunt

Core Tip: Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiological procedure that significantly reduces portal pressure, prevents decompensation and improves survival of cirrhotic patients. This editorial describes the milestones to optimize of TIPS technique, which have made it one of the main methods for the treatment of portal hypertension complications worldwide.