Thématique :
- Foie (hors cancers)
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
  2016 Jul;64(1):224-31  
  doi: 10.1002/hep.28547  
  Role of the transjugular intrahepatic portosystemic shunt in the management of severe complications of portal hypertension in idiopathic noncirrhotic portal hypertension.  
  Bissonnette J, Garcia-Pagán JC, Albillos A, Turon F, Ferreira C, Tellez L, Nault JC, Carbonell N, Cervoni JP, Abdel Rehim M, Sibert A, Bouchard L, Perreault P, Trebicka J, Trottier-Tellier F, Rautou PE, Valla DC, Plessier A  

Idiopathic noncirrhotic portal hypertension is a heterogeneous group of diseases characterized by portal hypertension in the absence of cirrhosis. The efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in this population are unknown. The charts of patients with idiopathic noncirrhotic portal hypertension undergoing TIPS in seven centers between 2000 and 2014 were retrospectively reviewed. Forty-one patients were included. Indications for TIPS were recurrent variceal bleeding (n = 25) and refractory ascites (n = 16). Patients were categorized according to the presence (n = 27) or absence (n = 14) of significant extrahepatic comorbidities. Associated conditions were hematologic, prothrombotic, neoplastic, immune, and exposure to toxins. During follow-up (mean 27 ± 29 months), variceal rebleeding occurred in 7/25 (28%), including three with early thrombosis of the stent. Post-TIPS overt hepatic encephalopathy was present in 14 patients (34%). Eleven patients died, five due the liver disease or complications of the procedure and six because of the associated comorbidities. The procedure was complicated by hemoperitoneum in four patients (10%), which was fatal in one case. Serum creatinine (P = 0.005), ascites as indication for TIPS (P = 0.04), and the presence of significant comorbidities (P = 0.01) at the time of the procedure were associated with death. Mortality was higher in patients with significant comorbidities and creatinine ≥100 μmol/L (P < 0.001).


In patients with idiopathic noncirrhotic portal hypertension who have normal kidney function or do not have severe extrahepatic conditions, TIPS is an excellent option to treat severe complications of portal hypertension. (Hepatology 2016;64:224-231).

Question posée
Rôle du TIPS dans la prise en charge des complications sévères en relation avec l’hypertension portale (HTP) des patients suivis pour une (HTP) idiopathique non cirrhotique.
Question posée
Etude rétrospective européenne dans un groupe de patients sévères avec une indication de TIPS pour hémorragie digestive récidivante ou ascite réfractaire avec ou non co-morbidités extra-hépatiques avec une mortalité plus élevée chez les patients ayant une créatininémie > 100 mmol/L et des co-morbidités.

Il faut certainement réserver ces indications de TIPS aux centres experts.