Hi wonderful community. My question is:
Has anyone had a TIPS procedure without having a gastric or esophageal bleed or without HE, ascites or any other of the many conditions associated with cirrhosis?
Currently have cirrhosis, enlarged spleen(14.5 cm) and grade 4 both esophageal and gastric varices. Just trying to get a gauge to see if anyone has had TIPS with no bleeds. I am thinking no one has had it but I would love to find out.
Many thanks!
The indications for a TIPSS (transjugular intrahepatic portal systemic shunt) are the following: 1- esophageal variceal bleed not responding to more conservative measures such as banding, variceal injections or beta blockers. 2- severe ascites not responsive to diuretics. It usually is not recommended for someone with esophageal varices without ever having had a variceal bleed unless there is some contraindication for endoscopic measures or beta blockers or it is being done for refractory severe ascites. TIPSS in people with advanced cirrhosis with a meld score above 18 have a relative contraindication to the procedure because of the possibility of liver decompensation. Hepatic encephalopathy (HE) is one of the possible complications of a TIPSS procedure so this is a contraindication to having the procedure done in the 1st place. Hope this helps.
Hi Panchotabla, Can you please tell me the source of your information ? I would like to reference it. I have never had HE, Ascites or any other complication yet. My hepatologist who is one of the best in the country indicated that the thinking on TIPS is changing and they are starting to recommend TIPS to help with severe portal Hypertension which I have.
Since being diagnosed January 2022, my MELD has remained a 7 but I do have Grade 4 varices that I was told are to big to be banded and there is risk of bleeding. I am taking 9.5 mg(Two pills) of carvedilol to lower the portal pressure and prevent bleeding. I am not sure how long this will work? I was told its just a matter of time before a bleed. I am not sure I want to wait and that is the dilemma.
Getting the TIPS procedure scares the living daylights out of me because of the possibility of getting HE after TIPS. The question is - will I still get HE and ascites in time regardless? I am also hesitant to now taking Xifaxan and lactulose daily. Right now I am only on the Carvedilol and Pravastatin which they did not want me to stop.
A lot to think about and consider. Thanks for your reply !
I am a retired gastroenterologist. Your hepatologist would have the latest info on TIPSS so I would definitely follow his recommendations. If you read carefully what I wrote, your hepatologist and I are not in disagreement. I mentioned that if there is some contraindication or exception to endoscopic measures then TIPSS could be an alternative. With a TIPPS procedure your chances of developing ascites diminish. As for HE, yes there is a chance of developing HE after TIPSS but it usually can be managed. If it becomes refractory the size of the shunt can be adjusted to shunt less blood from the liver to make the HE manageable or resolve altogether. The down side of this adjustment is that your portal pressures could rise but IR can usually keep it under the high risk levels. Bottom line, listen to your hepatologist. Don’t be afraid to express your concerns. Sounds to me like he/she is a keeper. I wish you well!
Thank you so much for taking the time to write and provide your feedback. I truly do value your input ! 👍
you’re very welcome. Feel free to reach out if you have any more questions or if you just want to “unload”. Good luck in all of your future endeavors.
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