Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival

Piecha, Felix; Radunski, Ulf K; Ozga, Ann‐Kathrin; Steins, David; Drolz, Andreas; Horvatits, Thomas; Spink, Clemens; Ittrich, Harald; Benten, Daniel; Lohse, Ansgar W.; Sinning, Christoph; Kluwe, Johannes

doi:10.1016/j.jhepr.2019.04.001

Cited by 34 publications

(29 citation statements)

References 44 publications

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“…In our cohort, most patients (80%) had more than 4 LVPs prior to allocation to TIPS, suggesting them more advanced in their liver disease progression. Thus, the mortality in our cohort is higher than in recent RCTs although similar to recent observational cohorts (35,65). However, the results of this study may encourage larger prospective multicenter studies.…”

Section: J O U R N a L P R E -P R O O Fsupporting

confidence: 79%

Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: J O U R N a L P R E -P R O O Fsupporting

confidence: 79%

Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation

et al. 2021

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“…Development of ascites is a poor prognostic factor in patients with cirrhosis, with a 1- and 2–year mortality of about 40 and 50%, respectively, and a median survival of 6 months once it becomes refractory to treatment [9]. In our population, TIPS placement was effective for refractory ascites, with response in 78.8% ( n = 26) of patients (33.3% achieving partial and 45.5% complete response), as seen in other reports [22, 30]. In our study, patients in whom ascites control failed were found to have significantly lower levels of baseline albumin, which is in line with the role of albumin in the pathophysiology of ascites [31].…”

Section: Discussionsupporting

confidence: 82%

Retrospective Study of Transjugular Intrahepatic Portosystemic Shunt Placement for Cirrhotic Portal Hypertension

Santos

Dantas

Gomes

et al. 2020

GE Port J Gastroenterol

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Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompressing clinically significant portal hypertension. The aims of this study were to evaluate clinical outcomes and adverse events associated with this procedure. Methods: Retrospective single-center study including 78 patients submitted to TIPS placement between January 2015 and November 2018. Follow-up data were missing in 27 patients, and finally 51 patients were included in the study sample. Data collected from individual registries included demographics, comorbidities, laboratory results, complications, and clinical results according to the indication. Results: Averagepre-TIPS portosystemic pressure gradient decreased from 18.1 ± 5 to 6 ± 3 mm Hg after TIPS placement. Indications for TIPS were refractory ascites (63%, n = 49), recurrent or uncontrolled variceal bleeding (36%, n = 28), and Budd-Chiari syndrome (1.3%, n = 1). TIPS-related adverse events occurred in 29/51 (56.8%) patients, with hepatic encephalopathy (HE) in 21 (41%) patients, sepsis in 3, liver failure in 2, hemolytic anemia in 1, acute pulmonary edema in 1, and capsular perforation in 1 patient. Mean follow-up was 15.7 ± 15 months. First-month mortality was 11.7% (n = 6) (sepsis, n = 3; acute liver failure, n = 2; and recurrence of variceal bleeding, n = 1) and was significantly higher for patients with Child-Pugh >9 points (p = 0.01), model of end-stage liver disease (MELD) scores >19 (p = 0.02), and for patients with a history of HE before the procedure (p = 0.001). Older age (p = 0.006) and higher levels of creatinine (p = 0.008) were significantly higher in patients developing HE after TIPS. Ascites persisted in 21.2% (7/33 patients) and was more frequent in patients with lower baseline albumin levels (p = 0.003). Recurrent variceal bleeding occurred in 22% (n = 4/18 patients) and was more frequent in patients with lower baseline hemoglobin levels (p = 0.03). Conclusion: TIPS is effective in up to 80% of patients presenting with variceal bleeding or refractory ascites. Careful patient selection based on age and HE history may reduce adverse events after TIPS.

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“…However, subgroup analyses performed on the pooled data of these RCTs showed that TIPS significantly improved TFS regardless of whether recurrent ascites patients were included or not in the trials[ 89 ]. A recent single-center retrospective study of 128 patients showed that placement of TIPS in patients with lower LVP frequency and creatinine levels is associated with superior ascites control[ 103 ]. Similar findings were reported by a prospective RCT comparing TIPS to LVP in patients with recurrent ascites and a limited LVP frequency, which demonstrated benefits in ascites control and survival in TIPS-treated patients but no difference in HE between the two groups[ 92 ].…”

Section: Ascitesmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Rajesh

George

Philips

et al. 2020

WJG

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More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding, the transjugular intrahepatic portosystemic shunt (TIPS) procedure continues to remain a focus of intense clinical and biomedical research. By the impressive reduction in portal pressure achieved by this intervention, coupled with its minimally invasive nature, TIPS has gained increasing acceptance in the treatment of complications of portal hypertension. The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy. Moreover, the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions, which was occasionally severe. While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents, hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS. It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS. The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax, portal hypertensive gastropathy, ectopic varices, hepatorenal and hepatopulmonary syndromes, non-tumoral portal vein thrombosis and chylous ascites. It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality. The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.

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Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival

Cited by 34 publications

References 44 publications

Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation

Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation

Retrospective Study of Transjugular Intrahepatic Portosystemic Shunt Placement for Cirrhotic Portal Hypertension

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

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