Journal of clinical gastroenterology
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J. Clin. Gastroenterol. · Nov 2007
Review Historical ArticleThe role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension.
Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiology technique that has shown a 90% success rate to decompress the portal circulation. As a non-surgical intervention, without requirement for anesthesia and very low procedure-related mortality, TIPS is applicable to severe cirrhotic patients, who are otherwise untreatable, for example, nonsurgical candidates. TIPS constitutes the most frequently employed tool to achieve portosystemic shunting. ⋯ The circulatory effects of TIPS are an attractive approach for the treatment of refractory ascites and hepatorenal syndrome, yet TIPS is not considered first line therapy for refractory ascites owing to unacceptable incidence of portosystemic encephalopathy. Pre-TIPS evaluation taking into account predictors of outcome is mandatory. The improved results achieved with covered-stents might expand the currently accepted recommendations for TIPS use.
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J. Clin. Gastroenterol. · Nov 2007
Endoscopic and surgical therapy for intrahepatic cholangiocarcinoma in the united states: a population-based study.
Intrahepatic cholangiocarcinoma (ICC) is a highly fatal disease with limited therapeutic options. The determinants, trends, and outcomes of different therapies for ICC are largely unknown in the United States. ⋯ Only a minority of patients with ICC receives potentially curative therapy. Young age is the strongest predictor of receiving potentially curative treatment. Older patients and those diagnosed in recent time periods are more likely to receive endoscopic palliation. Surgical resection was associated with improved survival. There was no difference in survival between surgical and endoscopic palliation.
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J. Clin. Gastroenterol. · Nov 2007
ReviewHepatic venous pressure gradient and outcomes in cirrhosis.
End-stage liver disease is characterized by the development of complications related to portal hypertension. Hepatic venous pressure gradient (HVPG), as an estimation of portal pressure, has been associated to the development of these complications. ⋯ However, HVPG has also been associated to the development or the outcome of other complications of portal hypertension, hepatocellular carcinoma, liver transplantation, and survival. This review analyses the published data regarding the association between the HVPG and the different possible outcomes in cirrhosis.