Esophageal varices. II. TIPS (transjugular intrahepatic portosystemic shunt) and surgical therapy.
The role of surgery in the prevention and treatment of variceal hemorrhage is reviewed. Types of available surgery, their physiologic basis, and literature supporting their use are discussed in the context of the natural history of variceal hemorrhage. The evolution of transjugular intrahepatic portosystemic shunt (TIPS) as a treatment modality for variceal hemorrhage is reviewed. The effects of TIPS on portal and systemic hemodynamics and clinical usefulness in the management of variceal hemorrhage are discussed. A treatment algorithm for the integrated use of the various treatments is provided.
Luketic
V A
VA
Department of Medicine, Medical College of Virginia Commonwealth University, Richmond, USA. vluketic@hsc.vcu.edu
Sanyal
A J
AJ
D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016031:Liver Transplantation; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D055502:Secondary Prevention; D013156:Splenectomy; D016896:Treatment Outcome