The usefulness of transjugular intrahepatic portosystemic shunts (TIPS), compared to total paracentesis, in the management of refractory ascites is unclear.
Researchers from the United States performed a multicenter, prospective, randomized clinical trial to compare these 2 modalities.
The research team randomized 109 subjects with refractory ascites to either medical therapy (sodium restriction, diuretics, and total paracentesis), or medical therapy plus TIPS.
They set the principal end points as recurrence of tense symptomatic ascites and mortality.
|Total number of deaths in the 2 groups was identical.|
The team created a technically adequate shunt in 49 of 52 subjects.
The researchers found that TIPS plus medical therapy was significantly superior to medical therapy alone, in preventing recurrence of ascites.
However, the total number of deaths in the 2 groups was identical.
In addition, the team found that there were no significant differences between the 2 groups, with respect to overall and transplant-free survival.
Furthermore, there was a higher incidence of moderate to severe encephalopathy in the TIPS group.
The team identified no differences in the number of subjects who developed liver failure, variceal hemorrhage, or acute renal failure.
Additionally, there were no differences between the 2 groups in the frequency of emergency-department visits, medically indicated hospitalizations, or quality of life.
Dr Arun Sanyal’s team concluded, “Although TIPS plus medical therapy is superior to medical therapy alone for the control of ascites, it does not improve survival, affect hospitalization rates, or improve quality of life”.