TIPS in variceal bleeding: New and old indications

Variceal bleeding is one of the most dreaded complications of cirrhosis and its occurrence is associated with significant morbidity and mortality. During the past 30 years preventative therapies have reduced the risk of the first variceal bleed. Once variceal bleeding occurs use of pharmacologic and endoscopic therapies prevent rebleeding in most patients. The existing recommendations are that TIPS only be used in those patients who fail medical therapy. We reviewed recent literature focusing on the role of early TIPS in management of acute variceal hemorrhage and prevention of re-bleeding.