Transjugular route intrahepatic portal vein stent shunt (TIPS) is one of the interventional techniques for the treatment of bleeding esophagogastric varices in portal hypertension. After more than 20 years of basic and clinical research, there has been a relatively consistent understanding of the value of TIPS for clinical applications. Compared with surgical treatment (shunt and dissection), TIPS has the advantages of being less invasive, having a higher technical success rate, controlling the diameter of the shunt tract, being able to embolize varices at the same time, and having a lower complication rate. However, there is some controversy regarding the use of TIPS. In particular, with the increasing use of endoscopic techniques, the volume of TIPS procedures in most hospitals shows a tendency to decrease, although TIPS has some advantages in terms of emergency hemostasis success rate and long-term outcome compared with endoscopic treatment. For patients with bleeding esophagogastric varices in portal hypertension, is endoscopic treatment really better than TIPS, and what are the “bottlenecks” limiting the use of TIPS? How to choose the indications for TIPS application in clinical practice? Is endoscopic treatment of variceal bleeding better than TIPS? In terms of treatment principle, TIPS has the effect of shunting (reducing portal vein pressure) and disconnecting (embolizing varicose veins), which should have lower recurrence rate and better long-term efficacy than the endoscopic route of varicose vein treatment (disconnecting flow alone). The clinical practice proves that after endoscopic treatment of varicose veins, although the portal vein pressure does not decrease or even increases, the patient can no longer bleed and the liver function is not affected. The former is located in the mucosal layer of the esophagogastrointestinal tract, and even protrudes into the lumen of the digestive tube in the form of venous bulbs, which are prone to rupture and bleeding after erosion by digestive juices or mechanical damage by food residues. The endoscopic treatment eliminates the “harmful varicose veins” and may result in the compensation of “harmless varicose veins”, so that the varicose veins in the mucosa of the gastrointestinal tract do not recur. TIPS is a non-selective shunt TIPS may cause malnutrition of liver tissue and liver atrophy due to reduced portal perfusion after shunt; in addition, hepatic encephalopathy after TIPS should not be ignored. Although some scholars believe that the left branch of portal vein mainly receives splenic venous return, and shunting the left branch of portal vein can reduce the incidence of postoperative hepatic encephalopathy, this view is not yet accepted by most scholars at home and abroad. Therefore, for most patients, there is no substantial difference between shunting the left or right branch of the portal vein, and except for the few who do have a splenic vein reflux advantage, it is generally appropriate to establish a shunt tract based on the ease of puncturing the portal vein branches. Shunt stenosis and restenosis Late shunt stenosis after TIPS is a clinically significant stenosis found during post-hospital follow-up The incidence of stenosis after shunt support with bare metal stents reported in the literature prior to 2005 ranged from 15% to 70%, with such a wide variation related to the duration of follow-up, follow-up examination methods, and diagnostic criteria, as well as to the operative technique, type of stent used, postoperative It is also related to the operation technique, type of stent used, postoperative anticoagulation and antiplatelet therapy, etc. In recent years, it has been reported that the incidence of stenosis obstruction after shunt support with overlapping stents is 5%-15%, but most of the follow-up time is ≤2 years, and the long-term patency rate remains to be observed. Hepatic encephalopathy The incidence of HE after TIPS is lower than after surgical shunts. Initially, when TIPS was applied, there were more cases of Child C liver function and higher incidence of HE (18%-45%). Several large sample case studies in 2005 (with bare metal stents supporting the shunt tract) reported an incidence of HE of 8%-20%, mostly mild, and the symptoms disappeared after medical treatment. In recent years, the use of overlapping stents has reduced the incidence of shunt stenosis but not the incidence of HE, and in some patients aggressive measures must be taken to improve the patient’s HE symptoms by blocking or narrowing the shunt. Hyperhemodynamic portal hypertension due to giant spleen Hyperhemodynamic portal hypertension due to giant spleen is one of the most difficult clinical problems to treat either endoscopically or by TIPS. From the perspective of emergency hemostasis, both TIPS and endoscopic treatment have a high success rate of immediate hemostasis, but the recurrence rate of bleeding is high, and the giant spleen and hypersplenism cannot be improved. Therefore, surgical treatment is currently the preferred option for these patients. TIPS indications: TIPS indications are: 1, ruptured esophagogastric varices bleeding, after conservative treatment (drug treatment, endoscopic treatment, etc.) is not effective; 2, repeated ruptured esophagogastric varices bleeding, after repeated endoscopic treatment still can not control bleeding; 3, no endoscopic treatment conditions of severe varices, regardless of the history of variceal rupture bleeding and rupture bleeding Those with moderate to severe fundic varices at higher risk should be considered for prophylactic TIPS if emergency measures are limited; 4. Those who need to manage ruptured variceal bleeding while awaiting liver transplantation. TIPS is contraindicated in patients with Child-Pugh grade C liver function, especially those with serum bilirubin, creatinine, and international normalized ratio above the upper limit of normal, unless emergency hemostasis is required. tIPS should be chosen with caution in patients with intractable ascites and patients with Bu-plus syndrome. tIPS has some efficacy in portal hypertensive gastropathy, hepatic pleural fluid, and hepatorenal syndrome, but the evidence is insufficient.