| Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. | |
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MedLine Citation:
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PMID: 14638358 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) is frequently used to treat patients with refractory ascites, but its role is controversial. We sought to determine from the literature the efficacy, morbidity, and mortality associated with TIPS for refractory ascites. METHODS: We searched MEDLINE and identified studies published in English from January, 1985, to March, 2003, that evaluated the effect of TIPS in patients with refractory ascites. Outcomes that were analyzed included complete resolution of ascites, reduction in ascites, mortality, encephalopathy, stenosis, and renal function. Data were analyzed on an intention to treat basis. RESULTS: Of 25 studies identified, 16 were included in the analysis. The pooled estimate for complete response at 6 months was 45% and for any response (complete and partial) was 63%. Pooled 6-month mortality after TIPS was 36%. Risk factors for mortality included renal insufficiency (serum creatinine >1.5 mg/dl), hyperbilirubinemia (total bilirubin >3 mg/dl), advanced age (>60 yr), and poor response to TIPS. The pooled rate of new or worsening encephalopathy after TIPS was 32%. In most cases, encephalopathy was managed medically or by reduction in shunt size; however, refractory cases were associated with 100% mortality in most studies. Studies reporting the effect of TIPS on kidney function showed improvement in creatinine clearance and urinary sodium excretion. CONCLUSIONS: TIPS is effective in eliminating ascites or substantially reducing ascites in cases refractory to medical therapy. Renal insufficiency, refractory encephalopathy, and hyperbilirubinemia were consistently associated with mortality after TIPS. In individuals with risk factors for mortality, alternative strategies should be recommended. |
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Authors:
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Mark W Russo; Asheesh Sood; Ira M Jacobson; Robert S Brown |
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Publication Detail:
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Type: Comparative Study; Journal Article; Review |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 98 ISSN: 0002-9270 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-25 Completed Date: 2004-01-05 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0421030 Medline TA: Am J Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 2521-7 Citation Subset: IM |
Affiliation:
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Department of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599-7080, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Ascites / diagnosis, mortality*, surgery* Cause of Death* Cohort Studies Female Humans Male Middle Aged Morbidity / trends Portasystemic Shunt, Transjugular Intrahepatic / methods, mortality* Prognosis Randomized Controlled Trials as Topic Recurrence Retrospective Studies Risk Assessment Severity of Illness Index Statistics as Topic Survival Analysis Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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