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Guideline review
Guideline review: transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension—a BSG guideline
  1. Dhaarica Jeyanesan,
  2. Vinay Kumar Balachandrakumar,
  3. Brian Hogan
  1. Institute of Liver Studies, King's College Hospital Liver Unit, London, UK
  1. Correspondence to Dr Brian Hogan, Institute of Liver Studies, King's College Hospital Liver Unit, London, London, UK; brianhogan{at}


The decision-making around transjugular intrahepatic portosystemic shunt (TIPSS) placement in the management of patients with chronic liver disease and portal hypertension (PH) is a regular challenge for hepatologists. In the UK, access has improved, with more than 35 hospitals now offering this service. However, its role in acute variceal bleeding, refractory ascites and other complications of PH continues to be redefined and expanded. In particular, the role of pre-emptive TIPSS has become more established and requires re-evaluation of pathways to enable equitable access for patients. Here, we summarise the key recommendations from the recently published British Society of Gastroenterology guidelines and expand on the challenges posed.


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  • Contributors DJ reviewed the literature, prepared the manuscript and produced tables. VKB edited the manuscript and BH revised and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.