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Intervention Review

TIPS versus paracentesis for cirrhotic patients with refractory ascites

  1. S Saab,
  2. JM Nieto,
  3. D Ly,
  4. BA Runyon

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 19 JUL 2004

DOI: 10.1002/14651858.CD004889


How to Cite

Saab S, Nieto JM, Ly D, Runyon BA. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004889. DOI: 10.1002/14651858.CD004889.

Author Information

*Dr Sammy Saab, Clinical Instructor, Medicine and Surgery 44-138 CHS (MC 168417), University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. Ssaab@mednet.ucla.edu.

Publication History

  1. Published Online: 19 JUL 2004

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This is not the most recent version of the article. View current version (18 OCT 2006)

 

Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Ten per cent of cirrhotic patients develop refractory ascites, which carries substantial morbidity and has a one-year survival of less than 50 per cent. Patients with refractory ascites may benefit from transjugular intrahepatic portosystemic stent-shunts (TIPS).

Objectives

To compare TIPS versus paracentesis standard treatment in patients with refractory ascites due to cirrhosis with regard to overall short- and long-term mortality, treatment efficacy, and complications.

Search strategy

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (July 2003), The Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 1, 2003), MEDLINE (1966 to July 2003), EMBASE (1980 to July 2003), and CINAHL (1982 to July 2003). We supplemented the searches with reading through scientific citations, review of citations in relevant primary articles, and hand-searched abstracts from national meetings.

Selection criteria

We included randomised clinical trials comparing TIPS and paracentesis with or without volume expanders for cirrhotic patients with refractory ascites.

Data collection and analysis

We evaluated the methodological quality of the randomised clinical trials by the generation of the allocation section, allocation concealment, and follow-up. Two independent observers extracted data from each trial. We contacted trial authors for additional information. Dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI).

Main results

Four randomised clinical trials, including 264 patients, met the inclusion criteria. Methodological quality was moderate. Thirty-day mortality (OR 1.00, 95% CI 0.10 to 10.06, P = 1.0) and 24-month mortality (OR 1.17, 95% CI 0.52 to 2.66, P = 0.70) did not differ significantly between TIPS and paracentesis treatment. TIPS significantly reduced ascites re-accumulation at three months (OR 0.07, 95% CI 0.03 to 0.18, P < 0.00001) and at 12 months follow-up (OR 0.14, 95% CI 0.06 to 0.28, P < 0.00001). Hepatic encephalopathy occurred significantly more often in the TIPS group (OR 2.11, 95% CI 1.22 to 3.66, P = 0.008). Gastrointestinal bleeding (OR 0.82, 95% CI 0.36 to 1.84, P = 0.63), acute renal failure (OR 0.64, 95% CI 0.15 to 2.72, P = 0.55), septicemia/infection (OR 1.05, 95% CI 0.22 to 4.94, P = 0.96), and disseminated intravascular coagulation (OR 0.82, 95% CI 0.26 to 1.84, P = 0.63) did not differ significantly between groups.

Authors' conclusions

TIPS removed ascites more effectively than paracentesis. After 12 months, the beneficial effects of TIPS on ascites was still present. Mortality, gastrointestinal bleeding, septicemia/infection, acute renal failure, and disseminated intravascular coagulation did not differ significantly between the two groups. Hepatic encephalopathy occurred significantly more often in the TIPS group.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Plain language summary

Patients with refractory ascites may benefit from transjugular intrahepatic portosystemic stent-shunts

Refractory ascites causes substantial morbidity in patients with cirrhosis. Randomised trials have compared transjugular intrahepatic portosystemic stent-shunts (TIPS) with paracentesis. Mortality, gastrointestinal bleeding, renal failure, or infection did not differ significantly between the two intervention groups. TIPS effectively decreased the risk of ascites fluid re-accumulation, but was associated with an increased risk of hepatic encephalopathy.