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Digestive Disease Interventions 2017; 01(04): 254-258
DOI: 10.1055/s-0037-1609042
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transjugular Intrahepatic Portosystemic Shunt in Ascites: Updates

Harry Trieu
1   Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
,
Edward Wolfgang Lee
1   Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
,
Stephen T. Kee
1   Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
› Author Affiliations
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Publication History

26 September 2017

30 October 2017

Publication Date:
26 December 2017 (online)

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Abstract

The 2009 update of the American Association for the Study of Liver Diseases (practice guidelines recommends transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of refractory ascites in patients who do not tolerate repeated large volume paracentesis (LVP). It also stated uncertain survival benefit and possible increase in the risk of hepatic encephalopathy (HE). Since this update was published, new studies concerning TIPS as therapy for refractory ascites have emerged. Five studies reported a significant survival improvement in patients who underwent TIPS compared with LVP for refractory ascites, while a single study noted improved survival rates in covered stent TIPS recipients. Three studies found a significantly greater prevalence of severe HE in TIPS recipients compared with LVP recipients; however, only one study reported a significant association between TIPS and increased development of HE of all grades. Based on our review of the current literature, we recommend TIPS over LVP for the treatment of refractory ascites. Further, covered stents should be used for TIPS creation whenever possible.

Keywords

TIPS - ascites - portal hypertension

Authors' Contributions

H.T., E.W.L., and S.T.K. equally contributed to this paper with conception and design of the study, data collection and analysis, statistical analysis, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.


Financial Support

None.


 

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