Transjugular intrahepatic portosystemic shunt (TIPS)

(Gastro 2017;152:157) ↓ ascites in 75%; ↑ CrCl, ↑ enceph, survival benefit over LVP remains controversial Contraindic: grade II enceph, CHF or pulm HTN, active infxn or biliary obstruction Complications: bleeding, fistula; stent thrombosis (1-y patency w/ coated stents ~80%); infxn (“endotipsitis”); new or ↑ enceph in 20–30% (Am J Gastro 2016;111:523), hemolysis Consider for liver transplant if above fail