Transjugular Intrahepatic Portosystemic Shunt (Tips) for the Management of Refractory Ascites in Cirrhosis

García–Tsao, Guadalupe

doi:10.1002/9780470987476.ch20

Cited by 3 publications

(1 citation statement)

References 53 publications

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“…In a median follow-up of around 11 months, the observed mortality in these studies was quite variable but averaged around 50%. 28 Controlled Trials of TIPS versus LVP Five prospective randomized trials comparing TIPS versus LVP have been published in full to date 21,[29][30][31][32] and are summarized in Tables 1 and 2. Not unexpectedly, all five trials demonstrate that TIPS is more effective than LVP in the control of ascites (Table 2), and except for one, 29 all studies demonstrate a higher incidence of encephalopathy 21,31 or of severe encephalopathy 30,32 in patients treated with TIPS. Regarding mortality, the most important end point, one study shows a higher mortality in patients randomized to TIPS due to a higher mortality in Child C patients 21 ; two trials, which include the largest number of patients, show no differences in mortality between the TIPS and LVP groups 30,31 ; one trial shows a significant survival benefit in favor of the TIPS group 32 ; and in the remaining trial, treatment with TIPS was independently predictive of a better survival; however, differences in survival probability were not statistically different.…”

Section: Uncontrolled Trialsmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt in the Management of Refractory Ascites

García–Tsao

2005

Semin intervent Radiol

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The purpose of this article is to describe the pathophysiological basis for the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and refractory ascites, the short- and long-term hemodynamic, biochemical, and hormonal changes after TIPS, and the results of controlled trials of TIPS in cirrhotic patients with refractory ascites. TIPS placement is associated with normalization of sinusoidal pressure and a significant improvement in urinary sodium excretion that correlates with suppression of plasma renin activity (indicative of an improvement in effective arterial blood volume). Although effective in preventing the recurrence of ascites, the efficacy of TIPS is offset by an increase in the incidence of severe hepatic encephalopathy, a high incidence of shunt dysfunction, and a higher cost without an overall survival benefit, which should be reevaluated in light of polytetrafluoroethylene-covered stents. TIPS placement is currently indicated in seleceted cirrhotic patients with refractory ascites who require more than two to three large-volume paracenteses per month.

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Section: Uncontrolled Trialsmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt in the Management of Refractory Ascites

García–Tsao

2005

Semin intervent Radiol

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Ascites and Its Complications

García–Tsao

2015

Yamada' S Textbook of Gastroenterology

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Evaluation and management of patients with refractory ascites

Senousy

Draganov

2009

WJG

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Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis (LVP) and transjugular intrahepatic portasystemic stent-shunt (TIPS) are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morbidity and mortality (most surgical options) rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.

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Transjugular Intrahepatic Portosystemic Shunt (Tips) for the Management of Refractory Ascites in Cirrhosis

Cited by 3 publications

References 53 publications

Transjugular Intrahepatic Portosystemic Shunt in the Management of Refractory Ascites

Transjugular Intrahepatic Portosystemic Shunt in the Management of Refractory Ascites

Ascites and Its Complications

Evaluation and management of patients with refractory ascites

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