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Guidelines
Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension
  1. Dhiraj Tripathi1,2,3,
  2. Adrian J Stanley4,
  3. Peter C Hayes5,
  4. Simon Travis6,
  5. Matthew J Armstrong1,2,3,
  6. Emmanuel A Tsochatzis7,
  7. Ian A Rowe8,
  8. Nicholas Roslund9,
  9. Hamish Ireland10,
  10. Mandy Lomax11,
  11. Joanne A Leithead12,
  12. Homoyon Mehrzad13,
  13. Richard J Aspinall14,
  14. Joanne McDonagh1,
  15. David Patch7
  1. 1 Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2 Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
  3. 3 NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
  4. 4 Gastroenterology Department, Glasgow Royal Infirmary, Glasgow, UK
  5. 5 Hepatology Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  6. 6 Department if Radiology, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
  7. 7 The Royal Free Sheila Sherlock Liver Centre, UCL Institute for Liver and Digestive Health, London, UK
  8. 8 University of Leeds, Leeds, UK
  9. 9 London, UK
  10. 10 Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
  11. 11 Walton on Thames, UK
  12. 12 Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  13. 13 Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  14. 14 Department of Hepatology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  1. Correspondence to Dr Dhiraj Tripathi, Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK; d.tripathi{at}bham.ac.uk

Abstract

These guidelines on transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of portal hypertension have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the Liver Section of the BSG. The guidelines are new and have been produced in collaboration with the British Society of Interventional Radiology (BSIR) and British Association of the Study of the Liver (BASL). The guidelines development group comprises elected members of the BSG Liver Section, representation from BASL, a nursing representative and two patient representatives. The quality of evidence and grading of recommendations was appraised using the GRADE system. These guidelines are aimed at healthcare professionals considering referring a patient for a TIPSS. They comprise the following subheadings: indications; patient selection; procedural details; complications; and research agenda. They are not designed to address: the management of the underlying liver disease; the role of TIPSS in children; or complex technical and procedural aspects of TIPSS.

  • portal hypertension
  • interventional radiology
  • ascites
  • oesophageal varices
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/gutjnl-2019-320221

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    Footnotes

    • Twitter @dtrip2015, @IanARowe

    • Collaborators British Society of Gastroenterology (BSG). British Society of Interventional Radiology (BSIR). British Association for the Study of the Liver (BASL).

    • Contributors Dr David Patch: chair of GDG and senior author. Dr Dhiraj Tripathi: co-author (all sections), BSG Liver Section Representative. Professor Adrian Stanley: co-author (TIPSS for ascites). Professor Peter Hayes: co-author (TIPSS for variceal bleeding and research recommendations). Dr Emmanuel Tsochatzis: co-author (TIPSS for ascites). Dr Ian Rowe: co-author (TIPSS for hepatic hydrothorax). Dr Matthew Armstrong: co-author (cardiac assessment, nutritional assessment). Dr Richard Aspinall: reviewer, BSG Liver Section Representative. Dr Joanna Leithead: co-author (TIPSS for hepatorenal syndrome). Dr Simon Travis: co-author (procedural details, service delivery and development). Dr Homoyon Mehrzad: reviewer. Dr Hamish Ireland: co-author (procedural details, service delivery and development).Sister Joanne McDonagh: reviewer. Mandy Lomax: co-author (patient summary). Nicholas Roslund: co-author (patient summary). All authors reviewed and approved the final document.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Dr David Patch: contribution to charity-administered educational fund for teaching purposes (Cook Medical). Dr Dhiraj Tripathi: educational funding (Gore Ltd). Chief investigator of CALIBRE trial investigating non-selective beta-blockers versus variceal band ligation in variceal bleeding (NIHR HTA funding). Member of National Institute of Health and Care Excellence (NICE) Interventional Procedures Advisory Committee (IPAC). Dr Homoyon Mehrzad: speaker fees (Gore Ltd) and educational funding (Gore Ltd). Professor Peter Hayes: speaker fees (Gore Medical). Dr Simon Travis: educational donations for sponsorship to attend scientific meetings and fund courses to train on specific equipment (Abbott Medical, Gore Ltd, Boston Scientific). Dr Richard Aspinall: trustee to charity Liver4Life. Other authors have not declared any conflicts of interest.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article.