Editor's note:

In response to the Belt and Road Initiative, and with the aim of sharing expertise and addressing shared health challenges, our hospital has launched the Overseas Promotion Program for New Medical Technologies. If you are interested in any of the medical technologies covered under this program, please feel free to contact the International Cooperation Office at faowch@163.com.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a minimally invasive interventional radiology procedure that creates a channel within the liver between the portal vein and the hepatic vein using a catheter introduced through the internal jugular vein. A metal stent maintains this tract, allowing blood to bypass the high-resistance liver tissue, thereby reducing portal venous pressure.

Clinical Indications

TIPS is primarily used to manage complications of portal hypertension, including:

·         Variceal bleeding refractory to endoscopic or medical therapy.

·         Refractory ascites or hepatic hydrothorax unresponsive to diuretics.

·         Secondary indications include Budd–Chiari syndrome, portal vein thrombosis with portal hypertension, and as a bridge to liver transplantation.

Contraindications and Risks

Contraindications include severe liver failure, right heart failure, severe pulmonary hypertension, active infection, and uncontrolled hepatic encephalopathy. Major complications include hepatic encephalopathy (10–30%), shunt stenosis or occlusion, and, rarely, liver failure or bleeding.

Clinical Effectiveness

TIPS controls variceal bleeding in over 90% of cases and effectively reduces portal pressure. For refractory ascites, it decreases the need for repeated paracentesis and improves quality of life. Covered stents enhance long-term patency. However, outcomes depend strongly on patient selection and post-procedure care.

Use in Belt and Road (BRI) Countries

Across BRI nations—spanning Asia, the Middle East, and Eastern Europe—liver cirrhosis from viral hepatitis (HBV, HCV), alcohol, and schistosomiasis remains a major cause of portal hypertension. Thus, TIPS represents a crucial therapy to prevent recurrent bleeding and ascites.

China, a key BRI country, has led regional development in TIPS. National guidelines (Chinese College of Interventionalists, 2019) recommend TIPS as standard care for refractory variceal bleeding and ascites. Studies from China show success rates above 90% and growing use as part of integrated liver-disease management. Similar adoption is emerging in Pakistan, Vietnam, Thailand, and Central Asian countries, supported by technology exchange and physician training programs under BRI health initiatives.

Many BRI countries face limited interventional radiology capacity, uneven access to imaging and stents, and restricted follow-up systems for monitoring shunt patency. Cost and post-TIPS management of hepatic encephalopathy also limit widespread use. Establishing training centers, shared protocols, and regional registries could enhance outcomes.

Conclusion

TIPS is an effective, life-saving therapy for portal hypertension complications. In Belt and Road countries, expanding access through collaboration, infrastructure development, and local guideline adaptation can greatly reduce mortality from cirrhosis and its complications—transforming liver-disease care across resource-diverse regions.