From the Guidelines
TIPS should not be performed as a first-line treatment in patients with grade one esophageal varices due to a lack of survival benefit and an increased risk of hepatic encephalopathy. The most recent guidelines, as outlined in the 2024 French guidelines on TIPS 1, indicate that TIPS is not recommended for secondary prophylaxis of variceal bleeding in patients with grade one esophageal varices. This recommendation is based on the lack of survival benefit and the increased risk of hepatic encephalopathy associated with TIPS in this patient population.
Key considerations for managing grade one esophageal varices include:
- Non-selective beta-blockers (NSBB) or endoscopic band ligation (EBL) as first-line treatments for secondary prophylaxis
- TIPS may be considered in patients with another indication for the procedure, such as recurrent ascites
- The risks associated with TIPS, including hepatic encephalopathy, shunt stenosis or thrombosis, and potential worsening of liver function, must be carefully weighed against the potential benefits
In clinical practice, the decision to perform TIPS in a patient with grade one esophageal varices should be made on a case-by-case basis, taking into account the patient's overall liver function, comorbidities, and bleeding risk factors, as well as the presence of other indications for TIPS, as suggested by the guidelines 1.
From the Research
TIPS Procedure in Grade One Esophageal Varices
- The studies provided do not directly address the performance of TIPS (Transjugular Intrahepatic Portosystemic Shunt) in grade one esophageal varices 2, 3, 4, 5, 6.
- However, it is mentioned that TIPS is recommended as a rescue therapy for bleeding from gastric fundal varices and is considered for patients with high-risk of dying or rebleeding from esophageal varices 4, 5, 6.
- The use of TIPS in patients with grade one esophageal varices is not explicitly stated, but it is implied that TIPS is typically reserved for more severe cases or when other treatments have failed 3, 6.
- Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis typically involves non-selective beta blockers (NSBBs) or endoscopic band ligation, with TIPS not being a first-line treatment 3, 6.
Indications for TIPS
- TIPS is considered for patients with uncontrolled bleeding or those who are likely to have difficult-to-control bleeding 6.
- It is also considered for patients with Child-Pugh B or C scores bleeding from gastric fundal varices 5.
- The decision to perform TIPS should be based on local resources and expertise, patient preference and characteristics, side-effects, and contra-indications 3.