TRANSJUGULAR INTRAHEPATIC PORTALSYSTEMIC SHUNT (TIPS) VERSUS DISTAL SPLENORENAL SHUNT (DSRS)

How is variceal bleeding treated?

  • Once the acute bleeding episode has been stabilized, treatment options are prescribed based on the severity of your symptoms and how well your liver is functioning.
  • If your liver is working adequately, variceal bleeding can be managed with relatively simple endoscopic therapy and medications. However, when this is not successful, more complex treatment requires reducing the pressure in the veins.
  • If your variceal bleeding is associated with end stage liver disease, you may require a liver transplant.

    FIRST LEVEL OF TREATMENT

    Endoscopy therapy and/or medications will be used to treat variceal bleeding when you are first diagnosed.

    Endoscopic therapy consists of either sclerotherapy or banding. Sclerotherapy is a procedure in which the varices are injected with a solution that causes thrombosis and scarring. Banding is a procedure in which rubber bands are used to block the blood supply to the varices.

    Medications such as beta blockers(propranolol), or nitrates (isosorbide mononitrate), may be prescribed alone or in combination with endoscopic therapy to reduce pressure in your varices and further reduce the risk of rebleeding. Endoscopic therapy and medications control bleeding in about 75% of patients.

    If the first level of treatment fails, you will require decompression (reducing the pressure) of your varices.

    SECOND LEVEL OF TREATMENT

    Two options for decompression are the Transjugular Intrahepatic Portalsystemic Shunt(TIPS) procedure and the Distal Splenorenal Shunt (DSRS) procedure.


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