Gastrointestinal endoscopy · 2025
Technical refinement in transjugular intrahepatic portosystemic shunt for cavernous transformation of the portal vein: role of endoscopic ultrasound-guided navigation (with video).
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Zhang Feng, Liang Siwei, Wang Chunxiang, Xiao Jiangqiang, Zhang Ming, Zhang Song, Zhang Wei, Li Wei, Lv Ying, Wang Lei, Zhuge Yuzheng
Аннотация
BACKGROUND AND AIMS: The procedure of transjugular intrahepatic portosystemic shunt (TIPS) for patients with cavernous transformation of the portal vein (CTPV) is difficult and complicated. In this study, we present a strategy to integrate EUS-guided navigation with TIPS.
METHODS: In this preliminary prospective cohort study, patients with liver cirrhosis and CTPV who were indicated for TIPS were consecutively enrolled between April 2023 and February 2025. Before TIPS, EUS-guided portal vein location was performed. The primary outcome was technical success and safety of EUS, and the secondary outcomes included clinical outcomes.
RESULTS: Ten patients were enrolled with a mean follow-up of 12 months (range, 2-24 months). All patients successfully underwent EUS-guided location and TIPS. No EUS-related adverse event was observed. During the follow-up, no patients experienced recurrent variceal hemorrhage or ascites. Three patients (30%) experienced overt hepatic encephalopathy.
CONCLUSIONS: The EUS-TIPS hybrid approach represents a paradigm shift in CTPV management, merging endoscopic precision with endovascular therapeutics.
METHODS: In this preliminary prospective cohort study, patients with liver cirrhosis and CTPV who were indicated for TIPS were consecutively enrolled between April 2023 and February 2025. Before TIPS, EUS-guided portal vein location was performed. The primary outcome was technical success and safety of EUS, and the secondary outcomes included clinical outcomes.
RESULTS: Ten patients were enrolled with a mean follow-up of 12 months (range, 2-24 months). All patients successfully underwent EUS-guided location and TIPS. No EUS-related adverse event was observed. During the follow-up, no patients experienced recurrent variceal hemorrhage or ascites. Three patients (30%) experienced overt hepatic encephalopathy.
CONCLUSIONS: The EUS-TIPS hybrid approach represents a paradigm shift in CTPV management, merging endoscopic precision with endovascular therapeutics.