Paracentesis or transjugular intrahepatic portosystemic shunting

Transjugular intrahepatic portosystemic shunting (TIPS) appears to reduce ascites, but it appears not to improve survival and it appears to increase the incidence of hepatic encephalopathy.

A systematic review including 5 studies with a total of 330 subjects was abstracted in DARE. Control of ascites was significantly more common with TIPS than with large volume paracentesis (LVP) at 4 months (66% versus 23.8%, RD 41.4%, 95% CI: 29.5 to 53.2, P<0.001; NNT 3) and at 12 months (54.8% versus 18.9%, mean difference 35%, 95% CI: 24.9 to 45.1, P<0.001). Encephalopathy was significantly more common with TIPS than with LVP (54.9% versus 38.1%, RD 17%, 95% CI: 7.3 to 26.6, P<0.001). There was no statistically significant difference between TIPS and LVP groups for survival at 1 year (61.7% versus 56.5%, RD 3.2%, 95% CI: -14.7 to 21.9) and 2 years (50% versus 42.8%, RD 6.8%, 95% CI: -10 to 23.6).

Comment: The quality of evidence is downgraded by the lack of detail on the review methods.

Ədəbiyyat

1. Deltenre P, Mathurin P, Dharancy S, Moreau R, Bulois P, Henrion J, Pruvot FR, Ernst O, Paris JC, Lebrec D. Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis. Liver Int 2005 Apr;25(2):349-56.