Transjugular Intrahepatic Portosystemic Shunt for Symptomatic Refractory Hepatic Hydrothorax in Patients With Cirrhosis

Dhanasekaran, Renumathy; West, J. Jason; Gonzales, Patrick; Subramanian, Ram; Parekh, Samir; Spivey, James R.; Martin, Louis G.

doi:10.1038/ajg.2009.634

Cited by 132 publications

(92 citation statements)

References 25 publications

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“…Gordon et al [14] Retrospective Patients with infection were excluded 12 patients had medically RHH; the rest of the 9 patients had TIPSS and RHH as a secondary indication with the primary indication being intractable ascites (n = 7) and gastric varices (n = 2) Jeffries et al [24] Retrospective chart review of 12 consecutive patients with medically RHH [26] Retrospective chart review of 40 [27] Retrospective chart review of 21 [28] Retrospective chart review of 28 [23] Retrospective chart review of 73 consecutive patients with medically RHH studies had a complete response (resolution of refractory hepatic hydrothorax without further need for thoracentesis) after TIPSS. There was no evidence of heterogeneity among studies (P = 0.99); B: About one-fifth [17.6% (10.9%-24.2%)] of the patients had only a partial response (defined as improvement in refractory hepatic hydrothorax symptoms and/or a decrease for the need for thoracentesis).…”

Section: Ref Methods and Patients Outcomes/complications Remarksmentioning

confidence: 99%

“…The procedure is often used as a bridge to liver transplantation in patients with end-stage liver disease. Since RHH is an uncommon complication of cirrhosis, most of the studies on the effectiveness of TIPSS have been limited to small numbers of patients, primarily in the form of case reports [19][20][21][22] or case series [3,14,[23][24][25][26][27][28] . Findings from these studies have varied substantially.…”

Section: Introductionmentioning

confidence: 99%

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Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

Ditah¹

2015

WJH

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AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis. METHODS:A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I 2 test. RESULTS:Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%). CONCLUSION:TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis. Core tip: Evidence on the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in patients with refractory hepatic hydrothorax (RHH) is scarce and variable. This paper summarizes available data on the effectiveness of TIPSS in RHH in a cumulative meta-analysis. The sum total of the evidence shows that TIPSS is associated with a clinically relevant response in three-quarters of patients with medically RHH. We suggest that TIPSS be considered early in patients with RHH, given its impact on quality of life and prognosis. However, caution should be exercised in older patients and those with severe underlying liver or renal dysfunction.Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis. World

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Section: Ref Methods and Patients Outcomes/complications Remarksmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

Ditah¹

2015

WJH

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“…The deterioration of hepatic function, hepatorenal syndrome, intraperitoneal hemorrhage, or hemobilia may also occur in rare cases 2, 3, 4, 5, 6. The approximate survival rates of patients who underwent the TIPS procedure were as follows: 3 months, 80%; 6 months, 75%; 1 year, 40–60%; 3 years, 25%; and 5 years, 15% 2, 6, 7…”

Section: Discussionmentioning

confidence: 99%

“…Namely, the Child–Pugh score (>12), Model of End‐stage Liver Disease (MELD) score (>22), and serum bilirubin level (>3 mg/dL) have been proposed as predictors of a bad prognosis 3, 4, 5. When patients are younger than 60 years old and their pre‐TIPS MELD score is <15 points, symptomatic recovery is estimated to be better 3, 6, 7. Our patient was 64 years old (>60 years), his Child–Pugh score was 13 (>12), and his MELD score was 21 (>15).…”

Section: Discussionmentioning

confidence: 99%

Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report

Kawahara

Tanaka

Isoi

et al. 2016

Acute Medicine & Surgery

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CaseA 64‐year‐old man with complaints of dyspnea and orthopnea secondary to a hepatic hydrothorax refractory to diuretic medication underwent the transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the portal vein pressure. The TIPS procedure failed due to severe liver stiffness. Direct intrahepatic portocaval shunt (DIPS), a modified TIPS procedure that directly inserts a stent from the inferior vena cava to the portal vein, was successfully carried out.OutcomeThe DIPS procedure significantly decreased the patient's pleural effusion and respiratory symptoms.ConclusionNo other medical treatment is available to control refractory pleural effusion caused by portal hypertension; however, the TIPS (or DIPS) procedure can be successfully carried out in patients <60 years old with a Model of End‐Stage Liver Disease score <15.

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“…TIPS has been evaluated for refractory hepatic hydrothorax in numerous small noncontrolled trials 70,68,69,70,71,72,73 . On the whole, 198 patients underwent TIPS with a response rate (both complete and partial) ranging from 59-82%.…”

Section: Refractory Hepatic Hydrothoraxmentioning

confidence: 99%