A 41 male with HCV and Child B cirrhosis is in the ICU with hematemesis. He presented one day prior with the same sign. An EGD at that time revealed bleeding esophageal varices. Band ligation was performed; octreotide drip was started, in order to decrease portal pressure by blocking splanchnic vasodilation.
The clinical dilemma now is knowing how to approach this episode of early rebleeding. Another attempt at band ligation? Send directly for TIPS? The link below is to a recent NEJM article that favors TIPS in scenarios like this. The 1-year actuarial survival was 61% in the pharmacotherapy–EBL group versus 86% in the early-TIPS group (P<0.001).
The image above shows a TIPS stent, acting as a conduit between a hepatic vein (top) and portal vein (bottom). In order to know whether a TIPS is functional, Doppler color studies are required to demonstrate proper blood flow.