PubMed · 4537327
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J N Crook, L W Gray, F C Nance, I Cohn. 1972. Upper gastrointestinal bleeding.. https://doi.org/10.1097/00000658-197205000-00017
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Transjugular intrahepatic portosystemic shunt (TIPS) was performed in one patient with refractory esophageal varices due to portal hypertension by liver cirrhosis. Rösch modified Z-stent was placed to keep the lumen. The shunt lowered average portal pressure from 45 to 24 mmHg, and then decompressed the esophageal varices. The shunt was patent still for three months after the creation. No significant complication was observed. This initial success of TIPS in Japan encouragingly support the safeness and effectiveness of this therapy.
Our first clinical experience of TIPSS made for a 52-year-old patient with recurrent life threatening variceal bleeding is described. Although shunt-making between the right hepatic vein and the right portal vein and placement of Gianturco-Rösch Z stents were successfully made without significant complication related to the procedure, sufficient decompression of the portal vein pressure was not obtained because of compression on these stents at the tortuous portion of the shunting tract. Some technical problems of the procedure are also discussed, especially about choice of metallic stents and puncture technique.
The authors submit their experience and data from the literature on the problem of oesophageal varices. In haemorrhage of varices at present the most successful procedure is endoscopic haemostasis concurrently with intensive treatment focused on the basic disease and replacement of blood losses. In patients with a history of haemorrhage from varices endoscopic sclerotization is generally recommended. The authors supplement it with the promising medicamentous reduction of the portal pressure. Other procedures, i.e. surgery, are indicated only in a minority of patients whose varices do not reposed to haemostasis and medicamentous reduction of high portal pressure. The problem how to proceed in varices which did not bleed so far is still unresolved. The authors recommend individual evaluation and submit their own procedure.