Australian best practice recommendations for transjugular intrahepatic portosystemic shunt (TIPS) in portal hypertension: a consensus statement

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is one of the preferred interventional radiology techniques for reducing clinically significant portal pressures in patients with cirrhosis and complications from portal hypertension when pharmacological therapy or endoscopic interventions have failed or been insufficient. Recent advances in TIPS procedural techniques and stent technology, along with emerging indications for TIPS, warrant a review of current practices and establishment of consensus recommendations in Australia, where TIPS remains underused. This TIPS consensus statement is the first such guideline in Australia. It outlines 69 evidence-based practice recommendations and the evidence underlying them. The recommendations are intended for use by health care professionals in Australia who manage adult patients with portal hypertensive complications of liver disease, where such patients are being considered for TIPS implantation, including pre-, peri- and post-procedural aspects of care. Methods and results: This consensus statement has been developed by specialists in hepatology and interventional radiology, with input from specialists in cardiology, hematology and primary care, including medical practitioners, nurses and clinical researchers. The statement deals with four domains related to TIPS: preparation for TIPS, patient selection and pre-TIPS workup; best procedural practice; postoperative care and follow-up; and indications for TIPS. Two rounds of a modified Delphi process were used to reach consensus on the recommendations. Conclusions: Adoption of and adherence to the evidence-based recommendations in this consensus statement should reduce clinical variation. Ultimately, this should lead to system-level improvements in quality of care and outcomes for patients undergoing TIPS implantation. These recommendations summarize the complete document, available at https://www.gesa.org.au/resources/.