Clinical Outcomes of Underdilated TIPS for Refractory Ascites and Variceal Hemorrhage

Transjugular intrahepatic portosystemic shunt (TIPS) placement is routinely used for the management of refractory ascites and recurrent variceal hemorrhage. Advantages of the TIPS include its less-invasive nature compared with a surgical shunt and lower shunt dysfunction (with the advent of covered stents). However, a major drawback of TIPS is risk for development of portosystemic encephalopathy (PSE), which appears to be partially related to the degree of portal shunting and TIPS diameter.

In a prospective, nonrandomized study, researchers compared clinical outcomes between 42 patients who received a TIPS that was underdilated to 6 to 7 mm and 53 patients who received a TIPS dilated to ≥8 mm. The mean follow-up was 326 days.

The 1-year proba…