Implementation, facility protocols, IR success requirements
This is the final of three blog posts focused on the benefits of early TIPS. Part 3 specifically addresses implementation, facility protocols, and IR success requirements. Read part 1, “Evidence and literature” here and part 2, “Patient selection” here.
Cook Medical sponsored a webcast discussion between specialists in interventional radiology and hepatology on the need for early transjugular intrahepatic portosystemic shunt (TIPS) procedures in patients who suffer from portal hypertension.
The program was moderated by Dr David Patch from the Royal Free Hospital in London and Prof. Otto M. van Delden from Amsterdam University Medical Center. Speakers included Prof. Bernhard Gebauer, director of the interventional radiology department at Charité Campus Virchow Clinic in Berlin; Dr Virginia Hernández-Gea from the Liver Unit at Hospital Clínic-IDIBAPS in Barcelona; and Dr Antonio Gaetano Rampoldi, from Niguarda Hospital in Milan.
While studies have shown the benefits of early TIPS intervention and defined the patient selection for this procedure, referring doctors may be unaware of the procedure and the need for a rapid response.
Dr Rampoldi explained the importance of educating physicians in smaller clinics who are often the first to see these at-risk patients. Referring hepatologists, gastroenterologists, and general practitioners should understand the literature and studies showing the importance of early TIPS procedures within 24 to 72 hours in this patient population.
According to Prof. Gebauer, referrals from other hospitals can often take too long. The patient might first be sent to the hepatology department, then for a second opinion with another examination, and then the hepatologist might try sclerotherapy and band ligation. Only after that, he said, will the radiologist be called to place the TIPS.
Unfortunately, accessibility to TIPS procedures may be limited within and among countries. Some hospitals in larger cities, such as Dr Rampoldi’s hospital in Milan, have a trauma centre that is available 24 hours a day throughout the year. “One-hundred percent of my team is able to perform TIPS,” he said. As with stroke therapy, he said, the patient must quickly get interventional treatment
In Spain, Dr Hernández-Gea said only large hospitals have IRs on call over the weekend.
According to Prof. Patch, it is more difficult to have quick access to TIPS in some areas of the United Kingdom. He said there is a variation in practice in the UK depending on locality. Some hospitals are able to deliver a 5/7 or 3/7 TIPS service while other hospitals provide 24/7 TIPS service. “These are quite important aspects in terms of delivery of care,” he said.
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