Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis.
Transjugular intrahepatic portosystemic shunt (TIPS) is a more effective treatment for refractory ascites than large volume paracentesis (LVP), but the magnitude of its effect in terms of control of ascites, encephalopathy and survival has not been established.


OBJECTIVE
This meta-analysis compare TIPS to LVP in terms of control of ascites at 4 and 12 months, encephalopathy and survival at 1 and 2 years.


RESULTS
Five randomized controlled trials involving 330 patients were included. In the TIPS group, control of ascites was more frequently achieved at 4 months (66% vs 23.8%, mean difference: 41.4%, 95% confidence interval (CI): 29.5-53.2%, P < 0.001) and 12 months (54.8% vs 18.9%, mean difference: 35%, 95% CI: 24.9-45.1%, P < 0.001), whereas encephalopathy was higher (54.9% vs 38.1%, mean difference: 17%, 95% CI: 7.3-26.6%, P < 0.001). Survival at 1 year (61.7% vs 56.5%, mean difference: 3.2%, 95% CI: -14.7 to 21.9%) and 2 years (50% vs 42.8%, mean difference: 6.8%, 95% CI: -10 to 23.6%) were not significantly different.


CONCLUSIONS
TIPS is a more effective treatment for refractory ascites than LVP. However, TIPS increase encephalopathy and does not improve survival.
Deltenre
P
P
Services d'Hépato-Gastroentérologie, Hôpital Huriez, CHRU Lille, France.
Mathurin
P
P
Dharancy
S
S
Moreau
R
R
Bulois
P
P
Henrion
J
J
Pruvot
F R
FR
Ernst
O
O
Paris
J C
JC
Lebrec
D
D
D000368:Aged; D001201:Ascites / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome