REGULAR CONTENT
Final ID
653
Type
Educational Exhibit-Poster Only
Authors
A Mohandas1, M Le1, K Patel1, M Harvill1, J Critchfield1
Institutions
1Detroit Medical Center/ Wayne State University, Detroit, MI
Purpose
Cirrhotic patients commonly present with ascites that is refractory to medical treatment. Repeated large volume paracentesis is often required for symptom alleviation in these patients. Transjugular intrahepatic portosystemic shunts (TIPS) provide a viable therapeutic alternative and precludes the necessity for repeated paracentesis and its associated risks such as infection and organ injury. We aim to provide an updated systematic review on the clinical outcomes of TIPS used for refractory ascites.
Materials & Methods
The medline and embase databases were searched from 1990 to January 2015 for randomized control trials and retrospective studies evaluating the clinical outcomes of TIPS in patients with refractory ascites. Relevant data were extracted from the final list of articles following scrutiny of their methodological quality. SPSS software, version 17 (SPSS, Chicago, IL) was used for statistical analysis.
Results
A final list of 11 articles including a total of 514 patients were selected. TIPS placement had a technical success rate of 97% with 57% of patients achieving symptom alleviation within 30 days of the procedure. Portosystemic pressure gradient was reduced from a mean of 20.8 to 9.1 mm of Hg. Shunt insufficiency or dysfunction was observed in 17% of the cases with frank occlusion occurring in 8% of them. Worsening or new onset hepatic encephalopathy was the major complication with an incidence of 41%. Gastrointestinal or variceal bleeding and worsening liver dysfunction was observed in 4% and 5% of the cases respectively. The incidence of other complications were as follows: renal failure in 3% of cases, hepatorenal syndrome in 2% of cases, heart failure or pulmonary edema in 2% of cases and sepsis in 1%.
Conclusions
TIPS has an excellent technical success rate and provides symptom alleviation in a proportion of cases that are refractory to medical treatment. Worsening hepatic encephalopathy is the most worrying complication although these articles report that many of the cases were subclincial and did not warrant further therapy. Complication rate apart from hepatic encephalopathy is low.
Final ID
653
Type
Educational Exhibit-Poster Only
Authors
A Mohandas1, M Le1, K Patel1, M Harvill1, J Critchfield1
Institutions
1Detroit Medical Center/ Wayne State University, Detroit, MI
Purpose
Cirrhotic patients commonly present with ascites that is refractory to medical treatment. Repeated large volume paracentesis is often required for symptom alleviation in these patients. Transjugular intrahepatic portosystemic shunts (TIPS) provide a viable therapeutic alternative and precludes the necessity for repeated paracentesis and its associated risks such as infection and organ injury. We aim to provide an updated systematic review on the clinical outcomes of TIPS used for refractory ascites.
Materials & Methods
The medline and embase databases were searched from 1990 to January 2015 for randomized control trials and retrospective studies evaluating the clinical outcomes of TIPS in patients with refractory ascites. Relevant data were extracted from the final list of articles following scrutiny of their methodological quality. SPSS software, version 17 (SPSS, Chicago, IL) was used for statistical analysis.
Results
A final list of 11 articles including a total of 514 patients were selected. TIPS placement had a technical success rate of 97% with 57% of patients achieving symptom alleviation within 30 days of the procedure. Portosystemic pressure gradient was reduced from a mean of 20.8 to 9.1 mm of Hg. Shunt insufficiency or dysfunction was observed in 17% of the cases with frank occlusion occurring in 8% of them. Worsening or new onset hepatic encephalopathy was the major complication with an incidence of 41%. Gastrointestinal or variceal bleeding and worsening liver dysfunction was observed in 4% and 5% of the cases respectively. The incidence of other complications were as follows: renal failure in 3% of cases, hepatorenal syndrome in 2% of cases, heart failure or pulmonary edema in 2% of cases and sepsis in 1%.
Conclusions
TIPS has an excellent technical success rate and provides symptom alleviation in a proportion of cases that are refractory to medical treatment. Worsening hepatic encephalopathy is the most worrying complication although these articles report that many of the cases were subclincial and did not warrant further therapy. Complication rate apart from hepatic encephalopathy is low.