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Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Transjugular intrahepatic portosystemic shunt (TIPS) has recently been reported to be effective in the treatment of cirrhotic patients with refractory ascites. However, the clinical utility of TIPS in the subset of refractory ascitic patients with good hepatic and renal function is uncertain. The aim of this study was to compare the efficacy of TIPS to that of large-volume paracentesis in cirrhotic patients with refractory ascites who have good hepatic and renal function.

Methods

Sixty cirrhotic patients with refractory ascites who presented with a Child–Pugh score of <11, serum bilirubin of <3 mg/dl and creatinine of <1.9 mg/dl were assigned randomly to TIPS (n = 30) or large-volume paracentesis plus albumin (n = 30). The primary endpoint was survival. The secondary endpoints were response to treatment and development of hepatic encephalopathy.

Results

The baseline characteristics were similar in the two groups. Seventeen patients treated with TIPS and 21 treated with paracentesis died during the study period. The cumulative probabilities of survival at 1 and 2 years were 80 and 64% in the TIPS group and 49 and 35% in the paracentesis group (p < 0.005). TIPS was significantly superior to paracentesis in the control of ascites (p < 0.005). Treatment failure was more frequent in the paracentesis group, whereas the frequency of hepatic encephalopathy was greater in the TIPS group.

Conclusions

In cirrhotic patients with refractory ascites who have good hepatic and renal function, TIPS improves survival and provides better control of ascites than large-volume paracentesis.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Yoshiyuki Narahara, Hidenori Kanazawa, Takeshi Fukuda, Yoko Matsushita, Hirotomo Harimoto, Hideko Kidokoro, Tamaki Katakura, Masanori Atsukawa, Yasuhiko Taki, Yuu Kimura, Katsuhisa Nakatsuka & Choitsu Sakamoto

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  1. Yoshiyuki Narahara
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  2. Hidenori Kanazawa
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  3. Takeshi Fukuda
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  4. Yoko Matsushita
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  9. Yasuhiko Taki
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Correspondence to Yoshiyuki Narahara.

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Narahara, Y., Kanazawa, H., Fukuda, T. et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol 46, 78–85 (2011). https://doi.org/10.1007/s00535-010-0282-9

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  • DOI: https://doi.org/10.1007/s00535-010-0282-9

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