Tips in the treatment of refractory ascites (RA)

Fejfar, Tomáš; Hůlek, P; Krajina, Antonı́n; Šafka, Václav; Lojík, M.; Mašková, Jana; Michl, A; Ryška, Pavel; Vaňásek, Tomáš; Niangová, I.

doi:10.1016/s0168-8278(00)80930-7

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“…MELD score classifies candidates undergoing TIPS based on objective laboratory findings, in contradistinction to the Child-Pugh classification which contains a subjective assessment that can lead to inter-observer variability based on clinicians' judgement. 29 30 31 32 Prior studies have shown that a MELD score of ≥18 is considered a high threshold cut-off for TIPS placement due to elective post-TIPS mortality, compared with a MELD <18 33 . However, a recent single center, retrospective study concluded that the mortality was ∼50% lower than expected when TIPS was performed in patients with MELD scores >18, suggesting the need for a prospective RCT.…”

Section: Management Of Refractory Ascitesmentioning

confidence: 99%

LVP vs TIPS for Refractory Ascites: Where Do We Stand?

Varma

Singh

Bready

et al. 2022

Digestive Disease Interventions

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Ascites is the most common complication of end stage liver disease. Refractory ascites is considered a poor prognostic indicator and impacts quality of life, overall survival and contributes significantly to the cost associated with its management. Serial large volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPS) placement are the most utilized procedures for the management of refractory ascites and have their advantages and disadvantages. The pathophysiology of ascites in cirrhosis is multifactorial which makes management complex, requiring the consideration of multiple clinical and biochemical variables to guide the appropriate management. This article provides a broad overview of LVP and TIPS, with review of the latest clinical trials and meta-analyses to help guide the management of refractory ascites and improve patient outcomes.

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