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Digestive Disease Interventions 2022; 06(02): 086-093
DOI: 10.1055/s-0042-1745863
Review Article

LVP vs TIPS for Refractory Ascites: Where Do We Stand?

Rakesh K. Varma 
1   Division of Interventional Radiology, University of Alabama at Birmingham, Alabama
,
Karan Bir Singh
2   Department of Internal Medicine, Avalon University School of Medicine, Willemstad, Curacao
,
Eric Bready
1   Division of Interventional Radiology, University of Alabama at Birmingham, Alabama
,
Deepak Singh
3   Caribbean Medical School, Caribbean Medical University, Willemstad, Curacao
,
Theresa M. Caridi
1   Division of Interventional Radiology, University of Alabama at Birmingham, Alabama
,
Mohamed Shoreibah
4   Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Alabama
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Abstract

Ascites is the most common complication of end stage liver disease. Refractory ascites is considered a poor prognostic indicator and impacts quality of life, overall survival and contributes significantly to the cost associated with its management. Serial large volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPS) placement are the most utilized procedures for the management of refractory ascites and have their advantages and disadvantages. The pathophysiology of ascites in cirrhosis is multifactorial which makes management complex, requiring the consideration of multiple clinical and biochemical variables to guide the appropriate management. This article provides a broad overview of LVP and TIPS, with review of the latest clinical trials and meta-analyses to help guide the management of refractory ascites and improve patient outcomes.

Keywords

refractory ascites - large volume paracentesis - transjugular intrahepatic portosystemic shunt - cirrhosis - portal hypertension

Note

Dr. Caridi receives grant support from Varian; consultant to Boston Scientific, Terumo, and Varian; speaker for Boston Scientific, Terumo; Medical advisory committee for Boston Scientific and serves as a Vice Chair for the Society of Interventional Radiology Foundation.




Publication History

Received: 30 September 2021

Accepted: 24 January 2022

Article published online:
05 May 2022

© 2022. Thieme. All rights reserved.

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