title: Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial.
abstract: 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.
authors.affiliation: 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
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Narahara
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsushita
authors.forename: Hirotomo
authors.initials: H
authors.lastname: Harimoto
authors.forename: Hideko
authors.initials: H
authors.lastname: Kidokoro
authors.forename: Tamaki
authors.initials: T
authors.lastname: Katakura
authors.forename: Masanori
authors.initials: M
authors.lastname: Atsukawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Taki
authors.forename: Yuu
authors.initials: Y
authors.lastname: Kimura
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Nakatsuka
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: 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
chemical_list: D000418:Albumins; D004232:Diuretics