TIPS for refractory ascites: a single-centre experience.
OBJECTIVE
Transjugular intrahepatic portosystemic shunt (TIPS) has been reported superior to large-volume paracentesis for refractory ascites, but post-TIPS encephalopathy is a major complication. We intended to assess the outcome of limited diameter TIPS on ascites control, mortality, and encephalopathy in patients with refractory ascites at our centre.


METHODS
TIPS was successfully performed on 56 patients. Initial stent dilatation was to 6 mm, if there was a reduction in portal pressure gradient (PPG) >25%, further dilatation was not proposed.


RESULTS
Either complete or partial response was obtained in 58%, 81%, 83%, and 93% of patients at 1, 3, 6, and 12 months, respectively. Mortality was 10%, 29%, 37%, and 50% at 1, 3, 6, and 12 months, respectively. In 27 patients (48%), a new episode of encephalopathy developed, but only 6 (22%) were grade III or IV and 23 (85%) responded quickly to treatment.


CONCLUSIONS
The results of our study confirm the efficacy of TIPS for refractory ascites. The use of narrow-diameter dilatation without aiming at lowering the PPG below a certain threshold might simplify the procedure and the follow-up for these patients.
Thalheimer
Ulrich
U
The Sheila Sherlock Hepatobiliarypancreatic and Liver Transplantation Unit, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Leandro
Gioacchino
G
Samonakis
Dimitrios N
DN
Triantos
Christos K
CK
Senzolo
Marco
M
Fung
Konrad
K
Davies
Neil
N
Patch
David
D
Burroughs
Andrew K
AK
D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D004106:Dilatation / Q000295:instrumentation / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology; D008107:Liver Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome