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TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update.
Gut. 2010 Jul; 59(7):988-1000.Gut

Abstract

Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. Large volume paracentesis and pleurodesis are regarded as first-line treatments in patients who do not respond adequately to diuretics. These treatments, however, do not prevent recurrence and carry the risk of worsening of the circulatory dysfunction leading to hepatorenal syndrome. The transjugular intrahepatic portosystemic shunt (TIPS) has been proposed as an alternative to paracentesis. TIPS reduces the rate of ascites recurrence mainly due to the reduction in the filtration pressure. In addition, TIPS results in a positive effect on renal function, including hepatorenal syndrome, demonstrated by a rapid increase in urinary sodium excretion, urinary volume, and improvement in plasma creatinine concentration. Furthermore, plasma renin activity, aldosterone, and noradrenalin concentrations improve gradually after TIPS insertion suggesting a positive effect on systemic underfilling, the factor of hepatorenal syndrome. As demonstrated recently in two meta-analyses including five randomised studies, TIPS also improves survival when compared with paracentesis. However, the evidence is based on relatively few studies with only 305 patients included. The positive effects of the TIPS are opposed by an increased frequency and severity of episodes of hepatic encephalopathy which may be reduced by both patient selection and reduced shunt diameter. Based on the present knowledge the recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates.

Authors+Show Affiliations

Praxiszentrum, Bertoldstrasse 48, Freiburg, Germany. martin-roessle@t-online.deNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20581246

Citation

Rössle, Martin, and Alexander L. Gerbes. "TIPS for the Treatment of Refractory Ascites, Hepatorenal Syndrome and Hepatic Hydrothorax: a Critical Update." Gut, vol. 59, no. 7, 2010, pp. 988-1000.
Rössle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut. 2010;59(7):988-1000.
Rössle, M., & Gerbes, A. L. (2010). TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut, 59(7), 988-1000. https://doi.org/10.1136/gut.2009.193227
Rössle M, Gerbes AL. TIPS for the Treatment of Refractory Ascites, Hepatorenal Syndrome and Hepatic Hydrothorax: a Critical Update. Gut. 2010;59(7):988-1000. PubMed PMID: 20581246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. AU - Rössle,Martin, AU - Gerbes,Alexander L, PY - 2010/6/29/entrez PY - 2010/6/29/pubmed PY - 2010/7/23/medline SP - 988 EP - 1000 JF - Gut JO - Gut VL - 59 IS - 7 N2 - Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. Large volume paracentesis and pleurodesis are regarded as first-line treatments in patients who do not respond adequately to diuretics. These treatments, however, do not prevent recurrence and carry the risk of worsening of the circulatory dysfunction leading to hepatorenal syndrome. The transjugular intrahepatic portosystemic shunt (TIPS) has been proposed as an alternative to paracentesis. TIPS reduces the rate of ascites recurrence mainly due to the reduction in the filtration pressure. In addition, TIPS results in a positive effect on renal function, including hepatorenal syndrome, demonstrated by a rapid increase in urinary sodium excretion, urinary volume, and improvement in plasma creatinine concentration. Furthermore, plasma renin activity, aldosterone, and noradrenalin concentrations improve gradually after TIPS insertion suggesting a positive effect on systemic underfilling, the factor of hepatorenal syndrome. As demonstrated recently in two meta-analyses including five randomised studies, TIPS also improves survival when compared with paracentesis. However, the evidence is based on relatively few studies with only 305 patients included. The positive effects of the TIPS are opposed by an increased frequency and severity of episodes of hepatic encephalopathy which may be reduced by both patient selection and reduced shunt diameter. Based on the present knowledge the recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/20581246/TIPS_for_the_treatment_of_refractory_ascites_hepatorenal_syndrome_and_hepatic_hydrothorax:_a_critical_update_ L2 - https://gut.bmj.com/lookup/pmidlookup?view=long&pmid=20581246 DB - PRIME DP - Unbound Medicine ER -