Transjugular intrahepatic portosystemic shunt (TIPS) was performed in one patient with refractory esophageal varices due to portal hypertension by liver cirrhosis. Rösch modified Z-stent was placed to keep the lumen. The shunt lowered average portal pressure from 45 to 24 mmHg, and then decompressed the esophageal varices. The shunt was patent still for three months after the creation. No significant complication was observed. This initial success of TIPS in Japan encouragingly support the safeness and effectiveness of this therapy.