Role of trans jugular intra-hepatic Porto-systemic shunt (tips)‎ in the management of refractory hepatic ascites and rebleeding varices

Abstract EN

Introduction: The two major complications of portal hypertension are refractory hepatic ascites and rebleeding esophageal varices.

TIPS procedure was invented to relief complications of portal hypertension until liver transplantation is available.

Aim: measure the efficacy and role of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment ٠/ variceal rebleeding and refractory hepatic ascites.

Patients: Seventy one patients were evaluated for TIPS insertion.

Patients in this study were selected among patients who were suffering from refractory hepatic ascites and recurrent hematemesis due to variceal bleeding.

Methods: All cases were subjected to history taking, general, abdominal examination, and investigations including imaging studies.

Inclusion criteria for patients with rebleeding varices were failure to prevent rebleeding from esophagogastric varices after a trial ٠/ medical and /or endoscopic secondary prevention.

Inclusion criteria for patients with refractory hepatic ascites was lack of response to Na restriction & intensive diuretic treatment for at least / wk (<0.8kg/4d) or development of diuretic induced complications with the need to therapeutic paracentesis.

We selected patients who suffered from tense ascites and more than 3 therapeutic paracentesis per month.

Results: The ages ofthe 71 patients ranged between 15 and 70 year's.

Sixty two percent of these patients were males.

The main etiology of cirrhosis in our patients was chronic hepatitis c infection.

The main indication for TIPS among the patients of this study was refractory ascites in 42 patients (59%).

Success rate ofthe procedure was 83.1%.

Seventy five percent (75%) of patients in this study with refractory ascites had a better clinical and sonographic grade of ascites, improved quality of life and less diuretic dose.

Reduction of variceal size by endoscopy occurred in (84.6%)) of patients.

Complete endoscopic disappearance of varices occurred in 12.8% of patients (5 patients out of 39).

Conclusion: TIPS procedure is an effective intervention in management ٠/ rebleeding varices and refractory hematic ascites with a good success rate and limited complications.