UCSF’s Contributions to Alternative Treatment of Liver Disease
The following was written by Jeanne M. Laberge, M.D., a Professor in Residence in the Department of Radiology and Biomedical Imaging at UCSF.
As mentioned in a previous blog post, Transjugular Interhepatic Portosystemic Shunts, or “TIPS,” is now a common alternative treatment for patients with cirrhosis and other forms of advanced liver disease.
UCSF played a major role in developing this minimally-invasive treatment. TIPS was conceived of about 30 years ago, and it had been performed at only a few institutions in this country, most notably at Oregon Health and Science University by Josef Rösch, MD. At the time, there was a problem with the procedure because the liver tissue would collapse and cause the channel being built in the liver to close down.
But in the early 1990s a new metal stent was devised, which allowed the channel in the liver to stay open longer. Ernest Ring, M.D., chief of Radiology at UCSF at the time, was among the first physicians in the United States to use these stents to create a practical shunt. Placing the stent in the shunt in the liver was able to keep the channel open for a long period time, which fixed the problem. UCSF and the Miami Vascular Institute were the first two locations where physicians were finding viably feasible ways of performing the procedure. TIPS became a dramatically beneficial procedure in many cases. At UCSF, we began to perform these procedures more frequently, before teaching the process to other hospitals and medical centers.
UCSF has become one of the leading teaching facilities where external interventional radiologists come to learn how to perform this alternative treatment. As a result, today TIPS is a much more common procedure used throughout the country to treat patients with liver disease and complications from liver disease. Currently, Robert Kerlan, M.D., chief of the Interventional Radiology section, continues to be very involved in this stent work. The Department performs approximately 40 to 50 cases annually, making UCSF among the highest volume locations in the world.
As for the future of this technology, we are continually working towards advancing the treatment of patients with portalhypertension. A number of other potential interventions are building off the concept of non-invasive entry into the portal vein to infuse medication. For example, we are working with UCSF liver transplant surgeons as they develop stem cell treatments to improve portalhypertension, as well as working to inject stem cells into the portal vein to treat diabetes.
The minimally-invasive treatment of liver disease through infusions in the portal vein is a promising new technology, and the work we have done with TIPS is a solid foundation for treating other conditions.
For more information on our experience with abdominal imaging at UCSF, please click here.