Esophagogastric variceal rupture and bleeding is the most dangerous complication in patients with cirrhosis, with a high mortality rate and easy recurrence. The most common treatment at present is endoscopic tissue adhesive injection ligation treatment + insulin drug treatment, which is a kind of flow disconnection method that needs to be performed several times, and the cost is about 10-20 thousand each time. Some patients with poor results or difficult to tolerate, or combined with ascites is difficult to subside, the choice of TIPS shunt decompression may be more advantageous, generally a single treatment can be, the cost of about 30,000 to 50,000. In general, both treatment methods have their advantages and disadvantages, and the costs are similar. Recently, our department and the Department of Radiology jointly implemented endoscopic combined TIPS treatment for a patient with good results, the first case in the past 20 years in Tongji, as follows: Patient Wang, female, 46 years old, was transferred to our department from an outside hospital on September 10, 2013 due to two days of vomiting blood and black stool. She was previously found to have unexplained liver cirrhosis and hypersplenism for 3 years. On admission: BP 130/93mmHg, HR 70bpm, clear consciousness, anemic appearance, no yellow sclera, no liver palm spider nevus. There was no special cardiopulmonary examination. The abdomen was slightly distended, no obvious varices were seen, the liver was not palpable under the ribs, and the spleen was large and flat. There was no pressure pain in the whole abdomen, and the mobile turbid sounds were positive. There was no edema in both lower limbs. Main laboratory tests after admission (2013.9.10): blood routine: WBC 2.4×10*9/L, Hb 73g/L, Plt 36×10*9/L; blood biochemistry: ALT 8U/L, TBil 8.6μmol/L, TP 60.1g/L, ALb 30.4g/L, Tchol 2.82mmol/L, blood ammonia 142μmol/L; coagulation function: PT 16.7s, APTT 41.9s, coagulation function: PT 16.7s. APTT 41.9s, prothrombin activity 62%, INR 1.36; complete set of blood transfusion: hepatitis B surface antigen (-), hepatitis B surface antibody (+), hepatitis B core antibody (+), hepatitis C antibody (-); complete set of self-exempt liver: anti-nuclear antibody (weakly positive), anti-hepatic and renal microsomal antibody (-), anti-mitochondrial antibody (-), anti-smooth muscle antibody (-). Anesthesia gastroscopy (2013.9.11): severe varices of esophagogastric fundic vein with red sign, multiple thrombotic heads seen in esophageal varices, portal hypertensive gastropathy. Portal vein multi-row CT imaging (2013.9.12): cirrhosis, splenomegaly, esophagogastric fundic varices, no ectopic varices or other shunts, ascites. The patient was diagnosed with cryptogenic cirrhosis in the decompensated stage with hemorrhage from ruptured esophagogastric fundic varices, hypersplenism, and a Child-Pugh score of 8. After admission, he was treated with rehydration, blood transfusion, acid suppression, growth inhibitors to lower portal pressure, liver protection, infection prevention, and support. The patient had a recurrence of vomiting blood on September 18, and was treated with emergency endoscopic fundic variceal tissue glue injection + esophageal variceal ligation and aggressive pharmacological treatment, and the patient’s bleeding stopped. Considering that the patient had repeated ruptured esophagogastric fundic variceal bleeding within a short period of time, combined with ascites, and the heart rate was mostly maintained at about 60 bpm, he could not be treated with β-blockers, and the Child-Pugh score was 10 after another bleeding, the surgical risk was high. A transjugular intrahepatic portosystemic shunt (TIPS) was performed on September 25, and a shunt was established by implanting a laminated stent in the right hepatic vein and the left branch of the portal vein, after which a significant improvement in gastric coronary varices was seen. The patient was discharged after resuming a semi-liquid diet. The patient did not vomit blood and black stool again, the ascites subsided, the mental status was good, and he was able to perform household chores. Ruptured esophagogastric variceal bleeding is the primary complication of cirrhosis. In 2009, the American College of Hepatology recommended endoscopic treatment + β-blocker therapy to prevent rebleeding in these patients, and TIPS is recommended for those who have difficulty controlling it. Compared to endoscopic treatment, previous TIPS treatment of ruptured variceal bleeding had a low rebleeding rate (18.9% vs 46.6%) and a high incidence of hepatic encephalopathy (34.0% vs 18.7%), with similar survival rates for both (27.3% vs 26.5%). Therefore, TIPS was included as second-line treatment for ruptured esophagogastric variceal bleeding in cirrhosis in 2009. A multicenter clinical study published in the New England Journal of Medicine in June 2010 presents a new perspective. In patients with active bleeding esophagogastric variceal veins in cirrhosis and Child-Pugh class C or B liver function, early TIPS treatment (with a laminated stent) within 72 hours of endoscopic hemostasis significantly reduces the risk of bleeding control failure, recurrent bleeding, and death without increasing the incidence of hepatic encephalopathy or exacerbating preexisting hepatic encephalopathy. In addition, with the widespread adoption of overlapping stents, the two-year patency rate of stents has increased from about 30% to more than 80%, which has greatly improved the problem of easy blockage of stents in TIPS patients. Therefore, for patients with active bleeding esophagogastric varices in cirrhosis and Child-Pugh class C or B liver function, TIPS has the potential to become the first-line treatment option, instead of just “wait and see” until the TIPS treatment is controlled by conservative medical or endoscopic treatment. In addition, TIPS is the treatment of choice for ectopic variceal bleeding in cirrhosis and refractory ascites, as well as for acute ruptured variceal bleeding that is difficult to control, portal hypertensive gastric disease, ruptured fundic vein bleeding, sinusoidal vasodilatation, refractory hepatic pleural fluid, and hepatorenal syndrome. Combined endoscopic treatment techniques and individualized selection of appropriate cases may be the future direction of TIPS.