Clinical efficacy of transjugular intrahepatic portosystemic shunt created with covered stents with different diameters: results of a randomized controlled trial.
OBJECTIVE
The incidence of post-TIPS hepatic encephalopathy (HE) could be reduced by using stents with a small diameter. The aim of this study was to compare the incidence of HE and the clinical efficacy of TIPS created with 8- or 10-mm PTFE-covered stents.


METHODS
Consecutive cirrhotics submitted to TIPS for variceal bleeding or refractory ascites were randomized to receive a 8- or 10-mm covered stent. As recommended by our Ethical Committee, the trial was stopped after the inclusion of 45 patients.


RESULTS
The two groups were comparable for age, sex, etiology, and psychometric performance. After TIPS, the portosystemic pressure gradient was significantly higher in the 8-mm stent group (8.9+/-2.7 versus 6.5+/-2.7 mmHg; p=0.007). Consequently, the probability of remaining free of complications due to portal hypertension was significantly higher in the 10-mm than in the 8-mm stent group: 82.9% versus 41.9% at one year; log-rank test, p=0.002. In particular, the persistence of ascites with the need for repeated paracentesis was significantly more frequent in the patients treated with 8-mm stent diameter for refractory ascites (log-rank test, p=0.008). The probability of remaining free of HE was similar in both groups. Cumulative survival rate was similar in both groups.


CONCLUSIONS
The use of 8-mm diameter stents for TIPS leads to a significantly less efficient control of complications of portal hypertension. HE remains an unsolved major problem after TIPS.
Riggio
Oliviero
O
II Gastroenterologia, Dipartimento di Medicina Clinica, La Sapienza Università di Roma, Italy. oliviero.riggio@uniroma1.it
Ridola
Lorenzo
L
Angeloni
Stefania
S
Cerini
Federica
F
Pasquale
Chiara
C
Attili
Adolfo Francesco
AF
Fanelli
Fabrizio
F
Merli
Manuela
M
Salvatori
Filippo Maria
FM
D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000628:therapy; D005260:Female; D006501:Hepatic Encephalopathy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D011594:Psychometrics; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome