Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial.
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) has recently been reported to be effective in the treatment of cirrhotic patients with refractory ascites. However, the clinical utility of TIPS in the subset of refractory ascitic patients with good hepatic and renal function is uncertain. The aim of this study was to compare the efficacy of TIPS to that of large-volume paracentesis in cirrhotic patients with refractory ascites who have good hepatic and renal function.


METHODS
Sixty cirrhotic patients with refractory ascites who presented with a Child-Pugh score of <11, serum bilirubin of <3 mg/dl and creatinine of <1.9 mg/dl were assigned randomly to TIPS (n = 30) or large-volume paracentesis plus albumin (n = 30). The primary endpoint was survival. The secondary endpoints were response to treatment and development of hepatic encephalopathy.


RESULTS
The baseline characteristics were similar in the two groups. Seventeen patients treated with TIPS and 21 treated with paracentesis died during the study period. The cumulative probabilities of survival at 1 and 2 years were 80 and 64% in the TIPS group and 49 and 35% in the paracentesis group (p < 0.005). TIPS was significantly superior to paracentesis in the control of ascites (p < 0.005). Treatment failure was more frequent in the paracentesis group, whereas the frequency of hepatic encephalopathy was greater in the TIPS group.


CONCLUSIONS
In cirrhotic patients with refractory ascites who have good hepatic and renal function, TIPS improves survival and provides better control of ascites than large-volume paracentesis.
Narahara
Yoshiyuki
Y
Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. y-nara@nms.ac.jp
Kanazawa
Hidenori
H
Fukuda
Takeshi
T
Matsushita
Yoko
Y
Harimoto
Hirotomo
H
Kidokoro
Hideko
H
Katakura
Tamaki
T
Atsukawa
Masanori
M
Taki
Yasuhiko
Y
Kimura
Yuu
Y
Nakatsuka
Katsuhisa
K
Sakamoto
Choitsu
C
D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D001201:Ascites / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D003131:Combined Modality Therapy; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D000418:Albumins; D004232:Diuretics