Diagnostic and therapeutic technology assessment. Transjugular intrahepatic portosystemic shunt (TIPS)
R. Miller-Catchpole
Department of Technology Assessment, American Medical Association, Chicago, Ill 60610, USA.
OBJECTIVE--To provide clinicians with a technology assessment of the safety
and effectiveness of the use of a transjugular intrahepatic portosystemic
shunt (TIPS) for reducing portal hypertension and its associated
complications of esophageal varices and ascites. PARTICIPANTS--A literature
review and a Diagnostic and Therapeutic Technology Assessment (DATTA)
survey questionnaire were mailed to 72 physicians with expertise in
gastrointestinal or abdominal surgery or interventional radiology and a
special interest in liver disease or esophageal varices. These panelists
had been nominated to the DATTA panel by appropriate specialty societies
and medical schools. A total of 54 panelists (75%) responded.
EVIDENCE--Assessment was based on the expert opinion of the panelists, as
well as on published scientific literature (available as of January 2,
1995). Published studies were identified by a MEDLINE search using the
terms transjugular intrahepatic portosystemic shunt, TIPS, and transjugular
and by review of the references cited in these primary sources. CONSENSUS
PROCESS--The respondents completed a DATTA survey questionnaire; the survey
results were tabulated, analyzed, and interpreted by an American Medical
Association staff physician. CONCLUSIONS--The safety of TIPS was considered
to be established in the acute control of bleeding from esophageal varices
in patients who had failed sclerotherapy. The safety of TIPS was considered
to be promising for long-term control of bleeding from esophageal varices.
In patients with end-stage liver disease and esophageal varices who are
liver transplant candidates, the use of TIPS was considered to be an
established therapy. The effectiveness of TIPS was considered to be (1)
established in the acute control of bleeding in patients who failed
sclerotherapy; (2) promising for long-term control of bleeding from
esophageal varices; and (3) established in patients with end-stage liver
disease and esophageal varices who are candidates for liver transplants.
