Abstract
Purpose
Transjugular intrahepatic portosystemic shunt (TIPS) has been reported superior to large-volume paracentesis for refractory ascites, but post-TIPS encephalopathy is a major complication. We intended to assess the outcome of limited diameter TIPS on ascites control, mortality, and encephalopathy in patients with refractory ascites at our centre.
Methods
TIPS was successfully performed on 56 patients. Initial stent dilatation was to 6 mm, if there was a reduction in portal pressure gradient (PPG) >25%, further dilatation was not proposed.
Results
Either complete or partial response was obtained in 58%, 81%, 83%, and 93% of patients at 1, 3, 6, and 12 months, respectively. Mortality was 10%, 29%, 37%, and 50% at 1, 3, 6, and 12 months, respectively. In 27 patients (48%), a new episode of encephalopathy developed, but only 6 (22%) were grade III or IV and 23 (85%) responded quickly to treatment.
Conclusions
The results of our study confirm the efficacy of TIPS for refractory ascites. The use of narrow-diameter dilatation without aiming at lowering the PPG below a certain threshold might simplify the procedure and the follow-up for these patients.
Similar content being viewed by others
References
Epstein M. Treatment of refractory ascites. N Engl J Med. 1989;321(24):1675–7.
Bories P, Garcia CD, Michel H, Bourel M, Capron JP, Gauthier A, et al. The treatment of refractory ascites by the LeVeen shunt. A multi-centre controlled trial (57 patients). J Hepatol. 1986;3(2):212–8.
Gines P, Arroyo V, Vargas V, Planas R, Casafont F, Panes J, et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med. 1991;325(12):829–35.
Gines P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, Del Arbol LR, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology. 2002;123(6):1839–47.
Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology. 2004;40(3):629–35.
Lebrec D, Giuily N, Hadengue A, Vilgrain V, Moreau R, Poynard T, et al. Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French Group of Clinicians and a Group of Biologists. J Hepatol. 1996;25(2):135–44.
Rossle M, Ochs A, Gulberg V, Siegerstetter V, Holl J, Deibert P, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med. 2000;342(23):1701–7.
Sanyal AJ, Genning C, Reddy KR, Wong F, Kowdley KV, Benner K, et al. The North American study for the treatment of refractory ascites. Gastroenterology. 2003;124(3):634–41.
Salerno F, Camma C, Enea M, Rossle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007;133(3):825–34.
Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996;23(1):164–76.
Patch D, Nikolopoulou V, McCormick A, Dick R, Armonis A, Wannamethee G, et al. Factors related to early mortality after transjugular intrahepatic portosystemic shunt for failed endoscopic therapy in acute variceal bleeding. J Hepatol. 1998;28(3):454–60.
LaBerge JM, Somberg KA, Lake JR, Gordon RL, Kerlan RK Jr, Ascher NL, et al. Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: results in 90 patients. Gastroenterology. 1995;108(4):1143–51.
Russo MW, Sood A, Jacobson IM, Brown RS Jr. Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. Am J Gastroenterol. 2003;98(11):2521–7.
Nair S, Singh R, Yoselewitz M. Correlation between portal/hepatic vein gradient and response to transjugular intrahepatic portosystemic shunt creation in refractory ascites. J Vasc Interv Radiol. 2004;15(12):1431–4.
Sherlock S, Dooley J. Diseases of the liver and biliary system. Oxford: Blackwell; 2002.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thalheimer, U., Leandro, G., Samonakis, D.N. et al. TIPS for refractory ascites: a single-centre experience. J Gastroenterol 44, 1089–1095 (2009). https://doi.org/10.1007/s00535-009-0099-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-009-0099-6