Paracentesis vs TIPS

Excerpt

Transjugular intrahepatic portosystemic shunting (TIPS) is a useful treatment modality for patients with cirrhosis and refractory or recurrent ascites. This study contrasts with a smaller study performed by Lebrec and colleagues (see Additional information), showing that TIPS may increase the chance of survival without liver transplantation when compared with large volume paracentesis. The response to treatment was significantly better in the TIPS group, with a reduced requirement for further paracentesis and diuretics. The authors were surprised to find that the incidence of hepatic encephalopathy was no worse with TIPS. They postulate that the negative effects of shunting are compensated for by improvements in renal function and electrolyte balance. TIPS appears to be a safe procedure, which takes approximately 1 h to perform, although reestablishment of the shunt is a fairly common occurrence. …