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Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis.
Gastroenterology. 2002 Dec; 123(6):1839-47.G

Abstract

BACKGROUND & AIMS

The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain.

METHODS

Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs.

RESULTS

Twenty patients treated with TIPS and 18 treated with paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 +/- 43 vs. 325 +/- 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the paracentesis group (P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the paracentesis group.

CONCLUSIONS

In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated paracentesis plus albumin.

Authors+Show Affiliations

Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), University of Barcelona, Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12454841

Citation

Ginès, Pere, et al. "Transjugular Intrahepatic Portosystemic Shunting Versus Paracentesis Plus Albumin for Refractory Ascites in Cirrhosis." Gastroenterology, vol. 123, no. 6, 2002, pp. 1839-47.
Ginès P, Uriz J, Calahorra B, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology. 2002;123(6):1839-47.
Ginès, P., Uriz, J., Calahorra, B., Garcia-Tsao, G., Kamath, P. S., Del Arbol, L. R., Planas, R., Bosch, J., Arroyo, V., & Rodés, J. (2002). Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology, 123(6), 1839-47.
Ginès P, et al. Transjugular Intrahepatic Portosystemic Shunting Versus Paracentesis Plus Albumin for Refractory Ascites in Cirrhosis. Gastroenterology. 2002;123(6):1839-47. PubMed PMID: 12454841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. AU - Ginès,Pere, AU - Uriz,Juan, AU - Calahorra,Blas, AU - Garcia-Tsao,Guadalupe, AU - Kamath,Patrick S, AU - Del Arbol,Luis Ruiz, AU - Planas,Ramón, AU - Bosch,Jaime, AU - Arroyo,Vicente, AU - Rodés,Juan, PY - 2002/11/28/pubmed PY - 2002/12/28/medline PY - 2002/11/28/entrez SP - 1839 EP - 47 JF - Gastroenterology JO - Gastroenterology VL - 123 IS - 6 N2 - BACKGROUND & AIMS: The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain. METHODS: Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs. RESULTS: Twenty patients treated with TIPS and 18 treated with paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 +/- 43 vs. 325 +/- 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the paracentesis group (P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the paracentesis group. CONCLUSIONS: In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated paracentesis plus albumin. SN - 0016-5085 UR - https://www.unboundmedicine.com/medline/citation/12454841/Transjugular_intrahepatic_portosystemic_shunting_versus_paracentesis_plus_albumin_for_refractory_ascites_in_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016508502004560 DB - PRIME DP - Unbound Medicine ER -