BACKGROUND: Randomized trials have shown that transjugular intrahepatic portosystemic shunt (TIPS) improves control of ascites compared with serial large volume paracentesis (LVP) in patients with refractory ascites. She has undergone Paracentesis (fluid removal) from abdomen in the past 2 months but ascites is not going away. Ascites became easily controlled with diuretics in 26 patients following TIPS. However, given a high operative morbidity and mortality in this patient population and a high rate of severe hepatic encephalopathy,17the surgical side-to-side portocaval shunt is practically never used for the treatment of refractory ascites. However, it is unclear whether TIPS affects long-term survival. The aim of our study was to investigate the short- and long-term effects of transjugular intrahepatic portosystemic shunt (TIPS) in the management of refractory ascites. Background: Transjugular intrahepatic portosystemic shunt (TIPS) placement improves survival in patients with refractory/recurrent acute variceal bleeding (RAVB) and refractory ascites/hydrothorax. However, 1 patient was lost to follow-up and 2 patients suffered acute compli-cations (fatal bleeding and immediate post-TIPS … 83 Surprisingly, the use of covered stents has been associated with a lower incidence of post-TIPS HE compared with bare metal stents in some studies. OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) is frequently used to treat patients with refractory ascites, but its role is controversial. Large volume paracentesis and The aim of our study was to investigate the short- and long-term effects of transjugular intrahepatic portosystemic shunt (TIPS) in the management of refractory ascites. A 10-mm PTFE-covered stent results in better control of refractory ascites in patients with cirrhosis, compared with an 8-mm stent, without increasing the incidence of HE. Article. February 2001; Gastroenterology 120(1):311-2 The treatments available for refractory ascites include serial paracentesis, TIPS, surgical shunting, and liver transplant. Patients with preserved liver function-characterized by a MELD score of less than 15 or a MELD score of less than 18 and an albumin value of 3 mg/dL or greater-experience the greatest survival benefit. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. Abstract. TIPS is a therapeutic alternative for the management of refractory ascites. Cases of refractory ascites that persist despite treatment may benefit from the placement of a transjugular intrahepatic portosystemic shunt (TIPS), which is a procedure that creates a new path for blood to flow from the portal vein to the liver, so as to alleviate portal hypertension. However, the data are limited and survival may not be improved in patients with poor liver function. Several randomized trials have compared TIPS to repeated large-volume paracentesis in the treatment of refractory ascites, which are … However, the effect of TIPS on liver transplant-free (LTF) survival is controversial. Devices such as an automated low-flow ascites pump may be available in the future for ascites treatment. TIPS is recommended for the management of refractory or recurrent gastroesophageal variceal bleeding, diuretic-intolerant and diuretic-refractory ascites, or hepatic hydrothorax.36 Data also suggest a benefit of TIPS in hepatorenal37 and hepatopulmonary syndromes38,39; however, the available data Fortunately, refractory ascites only occurs in 10% of patients with cirrhosis and ascites [ 37, 39, 40 ]. Six patients had Child-Pugh class B … Competing effects of hepatic encephalopathy, requirement for repeated LVP, and need for hospitalizations explain similar changes in quality of life between the two groups. There are various treatment options including diuretics to release fluid and diet changes. PURPOSE: To assess midterm results and examine factors associated with successful treatment of refractory ascites with creation of a transjugular intrahepatic portosystemic shunt (TIPS). The uncoated TIPS stents are … In summary, TIPS can improve renal function in type 1 and 2 HRS and eliminate ascites. PURPOSE: To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) in treatment of refractory ascites. In total, 222 patients receiving a TIPS for refractory ascites were identified, of which 131 patients had a complete documented work-up and were therefore included in this study. International ascites club Arroyo V etal .Hepatology ,1996 . Mainly, we wished to explore which of the predicting variables could be used to prefer large-volume paracentesis or TIPS. Background: Ten per cent of cirrhotic patients develop refractory ascites, which carries substantial morbidity and has a one-year survival of less than 50 per cent. Introduction. Different models have been proposed for the prediction of survival after TIPS. Transjugular intrahepatic portosystemic shunt (TIPS) has been reported superior to large-volume paracentesis for refractory ascites, but post-TIPS encephalopathy is a major complication. Management of refractory ascites: Are tips or taps tops? D’Amico G, Luca A, Morabito A, Miraglia R, D’Amico M. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Has a CRT pacemaker . TIPS (transjugular intrahepatic portosystemic stent-shunt) has been used increasingly in the management of refractory variceal bleeding. MATERIALS AND METHODS: Fourteen patients with chronic liver disease and portal hypertension were included in a prospective study. Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. Six patients had Child-Pugh class B disease; eight had class C … on the comparison of transjugular portosystemic shunt (TIPS) and repeated paracentesis. Its role in the management of refractory ascites and hepatorenal syndrome still awaits further prospective studies. She also has Diabetes for past 20 years and heart failure for past 6 years (LVEF 25-30%). Patients with preserved liver function—characterized by a MELD score of less than 15 or a MELD score of less than 18 and an albumin value of 3 mg/ dL or greater—experience the greatest survival benefit. The long-term outcome of TIPS for refractory ascites is unknown. My mother age 70 years is suffering form Liver cirrhosis and refractory ascites for the past 3/4 months. She also has Diabetes for past 20 years and heart failure for past 6 years (LVEF 25-30%). Transjugular intrahepatic portosystemic shunt (TIPS) is a radiological procedure used to decrease portal pressures. This revision was aimed to report the evidences on the treatment of patients with cirrhosis and refractory ascites. MATERIALS AND METHODS: In 50 patients with refractory ascites, TIPS creation was performed. Recently, early TIPS was shown to reduce rebleeding and improve survival compared to the conventional TIPS. Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for the secondary prevention of vari-ceal bleeding and management of refractory ascites. Refractory ascites is seen in 5-10% of patients with cirrhosis.Decompensated cirrhosis with refractory ascites has a mortality rate of around 40% in a year and a median survival of 6 months.Portal hypertension and splanchnic vasodilation are major factors in the development of ascites.The treatment of refractory ascites involves salt restriction, diuretics, large volume … There is emerging evidence that TIPS may also improve muscle mass. Once refractory ascites develops, one-year mortality is approximately 50%. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated therapy for refractory ascites and is superior at reducing the accumulation of fluid compared with paracentesis. 1,2 Treatment options consist in large volume paracentesis (LVP) with albumin infusion, 3 transjugular intrahepatic portosystemic shunt (TIPS), 4–7 automated low‐flow ascites … This study intends to evaluate the efficacy and safety of TIPS combined with subsequent microwave ablation in HCC patients with refractory ascites. Management of Refractory Ascites. Once refractory ascites develops, one-year mortality is approximately 50%. Options for treatment include optimization of medical management, serial large volume paracenteses, transjugular intrahepatic portosystemic shunt (TIPS), peritoneovenous shunt, and liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) creation is a safe and accepted treatment for both refractory ascites and hepatic hydrothorax, and has been shown to prolong survival [5] and achieve low (approximately 2530 %) recurrence [5, 6]. It corrects sinusoidal portal hypertension, becoming a rational and relatively safe therapeutic approach. The aim of this study was to compare the effects of TIPS and large-volume paracentesis in cirrhotic patients with refractory ascites by means of meta-analysis of individual patient data from 4 randomized controlled trials. TIPS placement using an ePTFE-covered stent-graft is an efficacious therapy for refractory ascites. NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical research findings and insightful commentary. Therapeutic options for refractory ascites include frequent paracentesis, transjugular intrahepatic portosystemic shunt (TIPS) placement, and liver transplant [8, 9, 11]. She has undergone Paracentesis (fluid removal) from abdomen in the past 2 months but ascites is not going away. Materials and methods: One hundred and forty-seven patients who underwent TIPS placement for refractory fluid accumulation were included. Refractory ascites is a serious complication of advanced cirrhosis with a 1-year transplant-free survival of 20-50%. Academic Article Overview abstract . Clinical and ultrasound follow-up were performed. Transjugular Portosystemic Stent Shunt (TIPS) basically reduces porto-systemic pressure gradient (PSG) and thereby reduces ascites and prevents bleeding from of varices [1-3]. Transjugular intrahepatic portosystemic shunt (TIPS) could effectively decrease portal hypertension-related complications. Multiple studies show better control of refractory ascites with TIPS than with large-volume paracenteses, but without a survival benefit. The aim of this study was to evaluate the predictive factors associated with patients' survival after TIPS placement for refractory ascites. Transjugular intrahepatic portosystemic shunt (TIPS) is frequently used to treat patients with refractory ascites, but its role is controversial. We intended to assess the outcome of limited diameter TIPS on ascites control, mortality, and encephalopathy in patients with refractory ascites at our centre. Refractory ascites (RA) is a common complication in patients with advanced chronic liver disease. TIPS is a proce-dure whereby a shunt is created between the portal vein and the hepatic vein. TIPS procedures are performed most commonly for secondary prevention or salvage therapy following variceal hemorrhage and for the management of refractory ascites. The positive effect of TIPS on renal function explains that the MELD score underestimates survival following TIPS for refractory ascites.100. In this prospectivestudy we evaluated the use of transjugular intrahepatic portosystemic shunt (TIPS) in 30 patients withrefractory ascites. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update Martin Ro¨ssle,1 Alexander L Gerbes2 ABSTRACT Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. TIPS has been used to manage the complications of portal hypertension in cirrhosis, including variceal hemorrhage and refractory ascites. TIPS improves serum sodium and creatinine levels [12, 13] and is more effective in controlling ascites than large-volume paracentesis. It is a procedure in which an intrahepatic stent is inserted between the hepatic and portal veins with intent for portal decompression to avoid the recurrence of ascites [ 30 ]. TIPS was successful in all and resulted in a 54% reduction in portacaval gradient (from 22.8 +/- 0.8 to 10.4 +/- 0.6 mm Hg). Patients with refractory ascites may benefit from transjugular intrahepatic portosystemic stent-shunts (TIPS). TIPS was successful in all andresulted in a 54% reduction in portacaval gradient (from22.8 ± 0.8 to 10.4 ± 0.6 … Transjugular intrahepatic portosystemic shunt (TIPS) Another treatment option for patients with refractory ascites is transjugular intrahepatic portosystemic shunt (TIPS). Introduction. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update Martin Ro¨ssle,1 Alexander L Gerbes2 ABSTRACT Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. World J Gastroenterol 2014;20:2704–2714. ROLE OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN REFRACTORY ASCITES The management refractory ascites is currently limited to large-volume paracenteses (LVPs) and transjugular intrahepatic portosystemic shunt (TIPS). Transjugular intrahepatic portosystemic shunt (TIPS) has been reported superior to large-volume paracentesis for refractory ascites, but post-TIPS encephalopathy is a major complication. Ascites is the most common complication of cirrhosis, impairs quality of life, and carries a poor prognosis. Purpose: To compare the outcomes in patients who had transjugular intrahepatic portosystemic shunts (TIPS) placed for hepatic hydrothorax with those who had it placed for refractory ascites. The treatment of ascites is based on symptomatic therapies, including sodium restriction and diuretics, as patients with ascites have a positive sodium balance. Refractory ascites (RA) is a common complication in patients with advanced chronic liver disease. We intended to assess the outcome of limited diameter TIPS on ascites control, mortality, and encephalopathy in patients with refractory ascites at our centre. Repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunting (TIPS) are commonly used interventions for patients with refractory ascites. The authors conclude that TIPS does not improve survival and is more expensive than paracentesis. TIPS is effective in eliminating ascites or substantially reducing ascites in cases refractory to medical therapy. Prognosis after the onset of RA is poor, with one-year-mortality rate of approximately 50%. Although all agree that TIPS reduces the recurrence rate of ascites, survival is controversial. Transjugular intrahepatic portosystemic shunt (TIPS) creation is a well-established and effective treatment for variceal bleeding and refractory ascites in patients with portal hypertension. In total, 222 patients receiving a TIPS for refractory ascites were identified, of which 131 patients had a complete documented work-up and were therefore included in this study. Refractory ascites is a serious complication of advanced cirrhosis with a 1-year transplant-free survival of 20-50%. Has a CRT pacemaker . Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated therapy for refractory ascites and is superior at reducing the accumulation of fluid compared with paracentesis. BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) placement improves survival in patients with refractory/recurrent acute variceal bleeding (RAVB) and refractory ascites/hydrothorax. Several randomized controlled trials have compared a transjugular intrahepatic portosystemic shunt (TIPS) with large-volume paracentesis in cirrhotic patients with refractory ascites. Ascites due to cirrhosis can be mobilized in approximately 90 percent of patients with a treatment regimen consisting of dietary sodium restriction (usually 88 mEq [2000 mg] per day) and oral diuretics (usually consisting of spironolactone and furosemide) [ … In these patients ascites may be treated with periodic paracentesis or with transjugular intrahepatic portosystemic shunt. Although all agree that TIPS re-duces the recurrence rate of ascites, survival is con-troversial. EFRACTORY ascites, a term introduced during the R 1950’s to define the ascites not responding to sodium restriction and diuretics, was an extremely frequent condition prior to the 1960’s, when the medical treatment of ascites consisted of the administration of mercurial or thiazide diuretics. The treatment options for refractory or recurrent ascites are repeated paracentesis, portosystemic shunt, peritoneovenous shunt and liver transplantation. Dear Sir: Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. The goal of TIPS creation is to reduce the portosystemic pressure gradient, and in the case for refractory ascites, to less than 12 mm Hg. TIPS reduces the portosystemic pressure gradient, one of the pathogenetic mechanisms of ascites formation, by functioning as a side-to-side portocaval shunt. Various therapeutic measures can be used for refractory ascites, including large-volume paracentesis, transjugular intrahepatic portosystemic shunt, vasoconstrictive drugs, and an automated low-flow ascites pump system. The aim of this study is to describe the natural history of patients with refractory ascites post-TIPS, and compared between polytetrafluoroethylene (PTFE)-covered versus bare stents. However, the role of TIPS in the management of complications of portal hypertension still awaits the outcome of clinical trials. Ascites develops as a result of portal hypertension, which leads to water–sodium retention and renal failure. My mother age 70 years is suffering form Liver cirrhosis and refractory ascites for the past 3/4 months. Response to TIPS with ascites clearance can lead to nutritional improvement. The treatments available for refractory ascites include serial paracentesis, TIPS, surgical shunting, and liver transplant. Since the study was planned in January 2017, 234 … Bercu et al. 4 Although a gradient less than 8 mm Hg is considered optimal by some, there is a tradeoff in terms of risk for encephalopathy with greater portosystemic shunting. shunt (TIPS) in 30 patients with refractory ascites. TIPS, or transjugular intrahepatic portosystemic shunting has been used to treat bleeding from esophageal varices (see Journal Watch accession number. Refractory ascites is a clinical manifestation associated with higher short-term mortality rates and timely evaluation for liver transplantation and/or TIPS should be performed [16, 41, 42]. Introduction The treatment options for refractory or recurrent ascites are repeated paracentesis, portosystemic shunt, peritoneovenous shunt and liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated therapy for refractory ascites and is superior at reducing the accumulation of fluid compared with paracentesis. MATERIALS AND METHODS: Fourteen patients with chronic liver disease and portal hypertension were included in a prospective study. The transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure that has proven benefit in the treatment of patients with RA. Recently, early TIPS was shown to reduce rebleeding and improve survival compared to the conventional TIPS. The most frequent complications of TIPS are the development of hepatic encephalopathy and a high incidence of shunt stenosis or occlusion after one year of follow-up. Renal insufficiency, refractory encephalopathy, and hyperbilirubinemia were consistently associated with mortality after TIPS. OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) is frequently used to treat patients with refractory ascites, but its role is controversial. This study compares transjugular TIPS, which may decrease the formation of ascites and improve renal function, with repeated large volume paracentesis. refractory ascites. However, only liver transplantation may improve the survival of such patients. The aim of this study was to compare the effects of TIPS and large-volume paracentesis in cirrhotic patients with refractory ascites by means of meta-analysis of individual patient data from 4 randomized controlled trials. 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