From the Guidelines
TIPS is a viable treatment option for ectopic varices in cirrhosis, particularly when bleeding is present and other treatments have failed, as it can effectively reduce portal pressure and decrease blood flow to varices. According to the 2017 practice guidance by the American Association for the Study of Liver Diseases 1, management of ectopic varices requires a multidisciplinary approach and treatment options include endoscopic therapy, TIPS with or without collateral embolization, and BRTO.
Key Considerations
- Ectopic varices are a rare but significant source of bleeding in patients with cirrhosis, and their heterogeneous localization and anatomy make standardization of treatment challenging 1.
- Diagnosis can be made with a thin-slice contrast-enhanced CT in the portal venous phase, and treatment options should be tailored to the individual patient's vascular anatomy and local hemodynamics.
- TIPS can be an effective treatment for ectopic varices, particularly when combined with collateral embolization, as it addresses the underlying pathophysiology of portal hypertension.
Treatment Approach
- A multidisciplinary approach involving endoscopists, hepatologists, interventional radiologists, and surgeons is essential for the management of ectopic varices 1.
- Treatment options should be evaluated on a case-by-case basis, taking into account the patient's overall clinical condition, liver function, and vascular anatomy.
- Regular ultrasound surveillance is necessary to monitor shunt patency after TIPS placement, and potential complications such as hepatic encephalopathy, shunt stenosis or occlusion, and procedure-related bleeding or infection should be carefully managed.
From the Research
Ectopic Varices in Cirrhosis and TIPS
- The provided studies do not directly address the use of Transjugular Intrahepatic Portosystemic Shunt (TIPS) for ectopic varices in cirrhosis.
- However, the studies discuss the indications and contraindications of TIPS placement for the treatment of complications of portal hypertension in cirrhosis, including variceal hemorrhage and ascites 2.
- TIPS may be indicated in patients with cirrhosis and acute variceal bleeding who are at high risk of failing standard therapy, such as those with a Child-Pugh score of 10-13 points or Child-Pugh B with active bleeding at endoscopy 2, 3, 4, 5.
- Early TIPS placement has been shown to improve survival and reduce rebleeding in patients with cirrhosis and acute variceal bleeding compared to standard treatment 3, 4, 5.
- The decision to use TIPS should be based on individual patient characteristics and the severity of variceal bleeding, underlying liver disease, and overall clinical status 3, 4, 5.
TIPS Placement and Ectopic Varices
- There is no direct evidence in the provided studies to support the use of TIPS for ectopic varices in cirrhosis.
- Further research is needed to determine the efficacy and safety of TIPS for ectopic varices in cirrhosis.
- The current evidence supports the use of TIPS for variceal hemorrhage and ascites in cirrhosis, but the application of TIPS to ectopic varices is not well established 2, 3, 6, 4, 5.