EARLIER TIPS PROCEDURES DEMONSTRATE POSITIVE PATIENT OUTCOMES
Increased survival and reduced complications
Data shows that earlier transjugular intrahepatic portosystemic shunt (TIPS) increases survival and reduces complications compared to large-volume paracentesis plus albumin (LVP + A) in select patients having advanced liver disease with portal hypertension. Further, earlier TIPS showed no difference in the incidence of hepatic encephalopathy (HE) compared to LVP + A.1
Earlier TIPS means:
- 3 in 1: Consider TIPS for patients who are getting at least 3 large-volume paracenteses (LVPs) in 1 year, despite optimal medical therapy2,3
- 72: Within 72 hours of admission after first bleeding incident for select patients with variceal bleeding2,3
For ascites
Earlier TIPS shows significant improvement in outcomes compared to LVP and albumin infusion at 1 year.1
For variceal bleeding
Evidence shows that early TIPS can significantly improve outcomes in select patients with liver disease.b,4
78%
transplant-free survival with TIPS
in Child-Pugh C patients with acute variceal bleeding (AVB) at 1 year vs 53% pharmacotherapy plus endoscopic band ligation (EBL) (P = .002)c,4
NO SIGNIFICANT DIFFERENCE
in the incidence of HE
For patients with variceal bleeding, earlier TIPS demonstrated 42.4% HE compared to 37.7% with pharmacotherapy plus EBL (P = .863)4
GREATER FREEDOM
from rebleeding and treatment failure
92% TIPS vs 74% pharmacotherapy plus EBL (P = .017) freedom from failure to control bleeding or prevent rebleeding in Child-Pugh B plus AB (active bleeding) and C patients4
LOWER FREQUENCY
de novo ascites or worsening of previous ascites
9.1% TIPS vs 47.6% pharmacotherapy plus EBL (P < .001) in Child-Pugh B plus AB and C patients4
Early TIPS also improves survival and control of bleeding compared to repeat endoscopic procedures with medical management
| Trial or study | Survival at 1 year | Prevention of rebleeding | Incidence of hepatic encephalopathy compared to pharmacotherapy combined with endoscopic therapy |
|---|---|---|---|
| Randomized Control Trial (RCT)5 | 86%c | 97%d | No significant difference |
| Post-RCT Surveillance Study6 | 86%c | 93%e | No significant difference |
| Observational Study4 | 78%c | 92%f | No significant difference |
For more information, access the full studies
a Early TIPS (n = 29) compared to large-volume paracenteses and albumen infusion (LVP + A) (n = 33).
b Early TIPS (n = 66) compared to pharmacotherapy plus endoscopic band ligation (EBL) (n = 605). Child-Pugh C patients with scores < 14.
c For a combined group of patients with Child-Pugh C (CP-C) score ≤ 13 or Child-Pugh B with active bleeding (CP-B plus AB) at diagnostic endoscopy.
d One-year actuarial probability of remaining free of failure to control bleeding and of variceal rebleeding.
e Primary study end point is composite outcome of failure to control acute bleeding or to prevent clinically significant variceal rebleeding. Data is presented as percentage that did not present the composite outcome.
f Composite end point of failure to control acute bleeding, early rebleeding, and late rebleeding. Data as presented is for CP-B plus AB and CP-C patients combined.
- Bureau C, Thabut D, Oberti D, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology 2017;152(1):157-163.
- Boike JR, Thornburg BG, Asrani SK, et al. North American practice-based recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension. Clinical Gastroenterology & Hepatology 2022;20(8):1636-1662.e36.
- European Association for the Study of the Liver. EASL clinical practice guidelines on TIPS. Journal of Hepatology 2025;83(1):177-210.
- Hernández-Gea V, Procopet B, Giráldez Á, et al; International Variceal Bleeding Observational Study Group and Baveno Cooperation. Preemptive-TIPS improves outcome in high-risk variceal bleeding: an observational study. Hepatology 2019;69(1):282-293. https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.30182
- García-Pagán JC, Caca K, Bureau K, et al. Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. New England Journal of Medicine 2010;362(25):2370-2379. https://www.nejm.org/doi/full/10.1056/NEJMoa0910102
- García-Pagán JC, Di Pascoli M, Caca K, et al. Use of early-TIPS for high-risk variceal bleeding. Results of a post-RCT surveillance study. Journal of Hepatology 2013;58(1):45-50.
This information is intended for education and awareness only. Patients should consult their physician for information on the risks associated with the devices and surgical procedures discussed in this website. All surgical procedures carry potential health risks. Not all patients will be candidates for treatment with these devices, and individual outcomes may vary.
Always follow physician advice on your post-surgery care and recovery.
Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. RXOnly
INDICATIONS FOR USE IN THE U.S.: The GORE® VIATORR® TIPS Endoprosthesis is indicated for use in the de novo and revision treatment of portal hypertension and its complications such as variceal bleeding, gastropathy, ascites which recurs despite conventional treatment, and/or hepatic hydrothorax.
INDICATIONS FOR USE IN CANADA: The GORE® VIATORR® TIPS Endoprosthesis with Controlled Expansion is indicated for use in the treatment of portal hypertension and its complications such as variceal bleeding and ascites which recurs despite conventional treatment.
CONTRAINDICATIONS: There are no known contraindications for this device.