A study of four cases of idiopathic portal hypertension with long-term follow-up: the potential benefits of transjugular intrahepatic portosystemic shunt

Abstract

We have explored the use of transjugular intrahepatic portosystemic shunt (TIPS) as a treatment option for idiopathic portal hypertension in four patients at our hospital. Although TIPS has been shown to be an effective means of managing this condition overseas, its use in Japan has been limited to date, owing to a lack of insurance coverage and concerns regarding the potential for a deterioration of hepatic function. However, we have achieved successful outcomes in the patient treated in this way, with improvements in her thrombosis, varices, and ascites. Although hepatic encephalopathy developed, it was manageable, and there was no subsequent decline in liver function or recurrence of ascites in the patients. This suggests that TIPS may represent a promising therapeutic option for Japanese patients, slowing the progression of her portal vein thrombosis. Although opinions vary regarding the optimal timing of TIPS, it is worth considering as a means of reducing portal blood pressure in Japanese patients.