TIPS versus paracentesis for cirrhotic patients with refractory ascites

TIPS removes ascites more effectively than paracentesis in cirrhotic patients with refractory ascites but is associated with increased risk of hepatic encephalopathy.

A Cochrane review included 5 studies, with a total of 330 patients, comparing TIPS (transjugular intrahepatic portosystemic stent-shunts) with paracentesis standard treatment in patients with refractory ascites due to cirrhosis. TIPS significantly reduced ascites re-accumulation at three months (OR 0.07, 95% CI 0.03 to 0.18, p<0.00001) and at 12 months follow-up (OR 0.14, 95% CI 0.06 to 0.28, p<0.00001). Mortality at 30-days (OR 1.00, 95% CI 0.10 to 10.06, p=1.0) and 24-months (OR 1.29, 95% CI 0.65 to 2.56, p=0.5) did not differ significantly between TIPS and paracentesis. Hepatic encephalopathy occurred significantly more often in the TIPS group (OR 2.24, 95% CI 1.39 to 3.6, p<0.01). Gastrointestinal bleeding, acute renal failure, septicemia/infection, and disseminated intravascular coagulation did not differ significantly between groups.

Ədəbiyyat

1. Saab S, Nieto JM, Lewis SK, Runyon BA. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev 2006 Oct 18;(4):CD004889.