Ferguson, J.W.; Chillingworth, S.; Tripathi, D.; Therapondos, G.; Redhead, D.; Hayes, P.C.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA108
Academic Journal
Ascites is a common and serious complication of cirrhosis with a 2 year mortality of approximately 50%. The treatment options are limited with only 2 RCTs comparing TIPSS to paracentesis. As a tertiary referral centre we have performed over 550 TIPSS procedures and have audited TIPSS insertion for refractory ascites. Methods: 563 TIPSS were performed between July 1991 and June 2002. The primary indication for 61 of these was refractory ascites and complete follow up was available in 35 cases. These patients were assessed at 3, 6 months and at 1 year. Survival was calculated using Kaplan Meier analysis on all 61 patients. Absence of response was defined as the persistence of ascites requiring paracentesis. Results: Of the 35 patients 20 had alcoholic liver disease, 7 viral hepatitis, 2 PBC, and 6 other aetiologies. Mean age at insertion was 55.9±11 years. 57.6% were Childs C and 42.4% were Childs B. TIPSS was successfully positioned in 32 of the 35 patients. Response rates were 36% at 3 months and 37% at 6 months (these percentages do not include patients who did not attend follow up but do include deaths). The estimated probability of survival without transplantation was 46.1% at 1 year. Of the 6 patients with encephalopathy prior to the procedure 3 (50%) developed worsening of their condition and 7 (27%) of the remaining patients developed encephalopathy. Conclusion: Response rates in our experience are relatively poor in comparison with other studies, however, mortality and post procedural encephalopathy rates are similar. Refractory ascites is associated with a poor prognosis in most patients and TIPSS helps in a minority. Better selection criteria are needed to select those who will benefit.


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