Abstract
The 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.
Keywords
TIPS - ascites - portal hypertension
