Abu Dhabi - UAE: Recently, a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure was performed successfully on a 3.5 years old child at Sheikh Khalifa Medical city (SKMC), managed by Cleveland Clinic, a SEHA healthsystem facility. The procedure was performed for the first time in this young age in the UAE by Dr Jamal Alkoteesh, Consultant Interventional Radiologist at SKMC. TIPS is an advanced Interventional Procedure which allows blood flow through the liver to normalize by relieving pressure in major veins that transport blood through the liver. Hence immediate risk of a major life threatening gastrointestinal bleed is significantly relieved. Future therapeutic decisions can now be made without the pressure of a major gastrointestinal bleed filling the agenda.
The child was referred to SKMC from Dubai suffering from gastric varices bleeding due to portal hypertension as a result of liver cirrhosis. She presented with massive gastric bleeding which Dr Souheil Shabib, Consultant Pediatric Gastroenterologist/Transplant Hepatologist managed to control after 3 hours of sclerosing and banding the bleeding sites. The risk of a second massive life -threatening bleed was very high and TIPS was the best option to avoid it.
Dr. Atul Mehta, Chief Medical Officer at SKMC, said that "TIPS procedure is carried out for certain patients who require liver transplant. The procedure usually will drastically lower the risk of complications for patients awaiting liver transplant. We constantly endeavor to innovate and create new avenues of patient care by pioneering procedures such as this across the UAE".
Dr. Shabib, stated that "today, TIPS is considered one the most convenient procedures to stabilize patients with liver diseases complicated by certain types of bleeding such as variceal bleeding in patients with portal hypertension in whom endoscopic treatment is insufficient. The procedure is considered "bridging the patient for liver transplant". He added that this patient is the youngest in the GCC and the Middle East to benefit from TIPS. The next older patient who had been treated with TIPS in the region was at 7 years of age and the procedure was performed at King Faisal specialist Hospital and Research center in Riyadh, Saudi Arabia.
Dr Alkoteesh stated that the procedure was done successfully with no complications through very tiny cut at the base of the neck less than 5mm and it was performed under general anesthesia and took 2 hours. The patient was discharged from the hospital 48 hours later and she is in good health now. "We are used to do the TIPS procedure at SKMC on adults but performing the TIPS procedure at this very young age is an achievement and to our knowledge is the first case of a successful TIPS procedure performed at this age in the UAE".
SKMC is owned and operated by SEHA, the Abu Dhabi Health Services Company, which is responsible for the curative activities of all the public hospitals and clinics in the Emirate of Abu Dhabi.
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About TIPS
"Transjugular, Intrahepatic, Portosystemic Shunt (TIPS) is a shunt (tube) placed between the portal vein which carries blood from the intestines to the liver and the hepatic vein which carries blood from the liver back to the heart. It is used primarily (but not exclusively) in patients with cirrhosis in which the scar tissue within the liver has blocked the flow of blood passing through the liver from the portal vein to the hepatic vein. The blockage increases the pressure in the portal vein leading to an increase in pressure in the portal vein (portal hypertension). As a result of the increase in pressure, blood flows around the liver via small, unimportant veins that connect the portal vein with other veins within the abdomen. These veins enlarge and are referred to as varices. Unfortunately, one of the places varices form is in the stomach and lower esophagus, and these varices have a tendency to bleed massively, frequently causing death from exsanguination. By providing an artificial path for blood traveling from the intestines, through the liver, and back to the heart, TIPS reduces the pressure in the varices and prevents them from rupturing and bleeding. There are several types of shunts that are placed surgically. TIPS is a non-surgical way of placing a portosystemic shunt. The shunt is passed down the jugular vein in the neck by a radiologist using x-ray guidance. The shunt then is inserted between the portal and hepatic veins within the liver".
What are some common uses of the procedure?
A TIPS is used to treat the complications of portal hypertension, including
variceal bleeding, bleeding from any of the veins that normally drain the stomach, esophagus, or intestines into the liver
varices, large veins that develop (usually across the esophagus and stomach) when there is a blockage in the blood flow throughout the liver portal
gastropathy, an engorgement of the veins in the wall of the stomach, which can cause severe bleeding ascites, the accumulation of high-protein fluid in the chest or abdomen Budd-Chiari syndrome, a blockage in one or more veins that carry blood from the liver back to the heart.
What are the benefits of the TIPS?
A TIPS is designed to produce the same physiological results as a surgical shunt or bypass, without the risks that accompany open surgery.
TIPS is a minimally invasive procedure that typically has a shorter recovery time than surgery.
Your TIPS should have less of an effect than open surgical bypass on future liver transplantation surgery, because the abdomen has not been entered.
The TIPS is contained entirely inside the diseased liver, and is removed with it during a transplant operation.
Studies have shown that this procedure is successful in reducing variceal bleeding in more than 90 percent of patients.
No surgical incision is needed--only a small nick in the skin that does not have to be stitched closed.
About SKMC
Sheikh Khalifa Medical City (SKMC), located in Abu Dhabi, UAE, operates under the management of Cleveland Clinic, named among the top hospitals in the USA by U.S. News and World Report. SKMC is owned by SEHA, the Abu Dhabi Health Services Company, recently established to oversee operations of all public hospitals in the Emirate. SKMC is the flagship institution for the public health system in Abu Dhabi and has several 'Centers of Excellence,' and aspires to practice contemporary medicine comparable to the best hospitals and medical centers in the world. SKMC provides comprehensive health care services in all of the disciplines relevant to the needs and priorities of the community to attain the highest levels of patient satisfaction.
SKMC consists of a 550-bed Acute Care Hospital and 14 specialized outpatient clinics accredited by the Joint Commission International (JCI). In addition, SKMC manages a 120-bed Behavior Sciences Pavilion, a 90-bed Rehabilitation Center, 9 primary healthcare centers and 2 dental centers distributed over the city of Abu Dhabi.
About SEHA
SEHA is health in Arabic. The Abu Dhabi Health Services Company - whose corporate identity is SEHA - is an independent, public joint stock company created to manage and develop the curative activities of the public hospitals and clinics of the Emirate of Abu Dhabi. SEHA is committed to providing quality, cost effective healthcare on par with international standards measured through accessibility, affordability, choice and satisfaction. SEHA owns and operates 12 hospital facilities, 2,644 licensed beds, and more than 40 Ambulatory and Primary Healthcare Clinics. SEHA is one of the largest employers in the Middle East with more than 16,500 doctors, nurses and other clinical staff and administration employed. For further information, visit us at www.seha.ae or contact James S Ferrier, Corporate Marketing Manager at jferrier@seha.ae or Salama Al Mazrouei, Corporate Marketing Specialist at smazrouei@seha.ae
© Press Release 2009
