Role of Tips in Acute Variceal Bleeding

Abstract Purpose of review We aimed to review the role of TIPS in acute variceal bleeding (AVB), focusing on preemptive-TIPS (p-TIPS) as discrepant data suggest room for refinement. Recent findings Salvage-TIPS can effectively control ongoing AVB despite first-line therapy, but mortality is high. Placing a p-TIPS to prevent failure in high-risk patients may improve survival. This is related to its effect decreasing the overall risk of a further decompensation (FD), not just rebleeding but also ascites and derived complications. Summary FD is closely related to death risk after AVB. The risk of FD and death concentrates in patients presenting with ascites ± HE in addition to AVB. p-TIPS improve survival, not only by decreasing rebleeding risk, but mainly FD overall. This review suggests potential improvements to optimize p-TIPS, such as improving risk stratification, restricting the indication to patients with AVB and ascites ± HE, or selectively identifying those at high-risk of failure (10%-15% cases) for an early placement. Research on these issues is warranted.