- Paper Report
- Open Access
Paracentesis vs TIPS
- Richard Venn1
© Current Science Ltd 2000
- Published: 8 September 2000
- liver transplantation
- transjugular intrahepatic portosystemic shunt
The treatment options for refractory or recurrent ascites are repeated paracentesis, portosystemic shunt, peritoneovenous shunt and liver transplantation. This study compares transjugular TIPS, which may decrease the formation of ascites and improve renal function, with repeated large volume paracentesis. Paracentesis is effective and safe but has disadvantages, including tense ascites between paracentesis, and bacterial peritonitis.
60 patients, with cirrhosis and refractory or recurrent ascites, randomised to TIPS (29) or paracentesis (31)
Primary outcome was survival without liver transplant
Requirement for paracentesis, incidence of encephalopathy, and creatinine clearance was assessed in both groups
TIPS could be offered for rescue therapy in the paracentesis group
Mean follow up period was nearly 4 years
Baseline characteristics were similar. Eleven patients in the TIPS group required reestablishment of the shunt, and five required a further reestablishment. There were no procedure-related deaths. In the paracentesis group 23 patients died and 15 died in the TIPS group (not significant). In the paracentesis group 10 patients received rescue TIPS. Paracentesis was performed on 21 occasions in the TIPS group and 280 times in the paracentesis group. Over the first 6 month follow-up period, the requirement for spironolactone was significantly reduced in the TIPS group. After 6 months, ascites had been eliminated in 15 patients in the TIPS group and five patients in the paracentesis group (P= 0.001). There were no differences between the groups in the incidence of hepatic encephalopathy, changes in liver function, and creatinine clearance over the follow-up period.
Lebrec D, Giuily N, Hadengue A, Vilgrain V, Moreau R, Poynard T, Gadano A, Lassen C, Benhamou JP, Erlinger S: Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. J Hepatol 1996, 25:135-144.