Transjugular Intrahepatic Portosystemic Shunt (TIPS)

AASLD develops evidence-based practice guidelines and practice guidances which are updated regularly by a multi-disciplinary panel of experts, including hepatologists, and include recommendations of preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. 

Practice Guideline

AASLD Practice Guidance on the Use of TIPS, Variceal Embolization, and Retrograde Transvenous Obliteration in the Management of Variceal Hemorrhage [updated June 2023]

Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been in use for more than 20 years to treat the complications of portal hypertension and TIPS have been created in thousands of patients with liver disease worldwide. Despite the extensive use of TIPS to treat the complications of portal hypertension there initially was a lack of consensus on which patients should receive a TIPS as compared to other forms of therapy. In 1995 a conference sponsored by the National Institutes of Health concluded that TIPS was effective in the acute control and prevention of recurrent bleeding from varices but it was unclear when TIPS should be used as compared to medical and surgical therapy for these complications of portal hypertension. In addition, the efficacy of TIPS to control refractory ascites or treat the Budd-Chiari syndrome was unclear but promising. Since then, more than one thousand patients have been enrolled in multiple controlled trials comparing TIPS to endoscopic and pharmacologic therapy in the prevention of rebleeding from varices and to large volume paracentesis in the treatment of refractory cirrhotic ascites. Further, about a 1,000 papers have been published on TIPS in the English literature alone. This body of work allows for more definitive recommendations about in whom and when to use TIPS in the treatment of the complications of portal hypertension.

This AASLD Practice Guidance aims to equip care providers with an in-depth understanding of the use of TIPS and/or variceal embolization/obliteration in the management of esophageal, gastric and ectopic variceal hemorrhage.