Transjugular Intrahepatic Portosystemic Shunt in Ascites: Updates

Abstract

AbstractThe 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.