title: A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites.
abstract: BACKGROUND
  In patients with cirrhosis and ascites, creation of a transjugular intrahepatic portosystemic shunt may reduce the ascites and improve renal function. However, the benefit of this procedure as compared with that of large-volume paracentesis is uncertain.
  
  
  METHODS
  We randomly assigned 60 patients with cirrhosis and refractory or recurrent ascites (Child-Pugh class B in 42 patients and class C in 18 patients) to treatment with a transjugular shunt (29 patients) or large-volume paracentesis (31 patients). The mean (+/-SD) duration of follow-up was 45+/-16 months among those assigned to shunting and 44+/-18 months among those assigned to paracentesis. The primary outcome was survival without liver transplantation.
  
  
  RESULTS
  Among the patients in the shunt group, 15 died and 1 underwent liver transplantation during the study period, as compared with 23 patients and 2 patients, respectively, in the paracentesis group. The probability of survival without liver transplantation was 69 percent at one year and 58 percent at two years in the shunt group, as compared with 52 percent and 32 percent in the paracentesis group (P=0.11 for the overall comparison, by the log-rank test). In a multivariate analysis, treatment with transjugular shunting was independently associated with survival without the need for transplantation (P=0.02). At three months, 61 percent of the patients in the shunt group and 18 percent of those in the paracentesis group had no ascites (P=0.006). The frequency of hepatic encephalopathy was similar in the two groups. Of the patients assigned to paracentesis in whom this procedure was unsuccessful, 10 received a transjugular shunt a mean of 5.5+/-4 months after randomization; 4 had a response to this rescue treatment.
  
  
  CONCLUSIONS
  In comparison with large-volume paracentesis, the creation of a transjugular intrahepatic portosystemic shunt can improve the chance of survival without liver transplantation in patients with refractory or recurrent ascites.
authors.affiliation: Medizinische Klinik II, Albrecht-Ludwigs-Universität, Department of Gastroenterology, Freiburg, Germany. roessle@mm21.ukl.uni-freiburg.de
authors.forename: M
authors.initials: M
authors.lastname: Rössle
authors.forename: A
authors.initials: A
authors.lastname: Ochs
authors.forename: V
authors.initials: V
authors.lastname: Gülberg
authors.forename: V
authors.initials: V
authors.lastname: Siegerstetter
authors.forename: J
authors.initials: J
authors.lastname: Holl
authors.forename: P
authors.initials: P
authors.lastname: Deibert
authors.forename: M
authors.initials: M
authors.lastname: Olschewski
authors.forename: M
authors.initials: M
authors.lastname: Reiser
authors.forename: A L
authors.initials: AL
authors.lastname: Gerbes
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019152:Paracentesis; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis