Final answer:
The number of endoscopic attempts before considering TIPS or surgical shunting for a variceal bleed is decided on a patient-by-patient basis, influenced by the severity of bleeding and patient's response to treatment. Endoscopic procedures are common and often lifesaving despite inherent risks. Determining responsibility for adverse outcomes depends on the specific circumstances of each case.
Step-by-step explanation:
The number of endoscopic interventions for a variceal bleed before a transjugular intrahepatic portosystemic shunt (TIPS) or surgical shunting is considered varies based on clinical guidelines, the patient's response to initial treatments, and the risk-benefit analysis of repeated endoscopic procedures versus more invasive surgical options.
While there is no fixed number of endoscopic attempts defined universally, the decision is typically made on a case-by-case basis by a medical team based on factors including the severity of the bleeding, the effectiveness of endoscopic treatment in controlling the bleed, the patient's overall health, and potential risks associated with more invasive procedures like TIPS or surgery.