Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis

Ginès, Pere; Úriz, J.; Calahorra, B.; García–Tsao, Guadalupe; Kamath, Patrick S.; Arbol, L Ruíz del; Planas, Ramón; Bosch, Jaime; Arroyo, Vicente; Rodés, Juan

doi:10.1053/gast.2002.37073

Cited by 501 publications

(351 citation statements)

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“…In selected patients with RA, a transjugular intrahepatic portosystemic shunt (TIPS) is a therapeutic alternative to repeated LVPs [9]. Unfortunately, TIPS is contraindicated in patients with marked pulmonary arterial hypertension, heart failure, advanced liver disease, significant hepatic encephalopathy, uncontrollable coagulopathy, and elevated right or left heart pressures [10].…”

mentioning

confidence: 99%

Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study

Bureau

Adebayo

Rieu

et al. 2017

Journal of Hepatology

107

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mentioning

confidence: 99%

Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study

Bureau

Adebayo

Rieu

et al. 2017

Journal of Hepatology

107

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“…The 27% 90-day survival rate for the current study patients with ascites is far below the reported range of 1-year transplantation-free survival rates of 41-69% for patients with ascites who underwent TIPS. 4,41 Therefore, we caution the use of TIPS in the subgroup of patients who have concomitant malignancies and hepatogenic ascites and in the subgroup of patients who have hepatic primary malignancies, regardless of indication.…”

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Wallace

Madoff

Ahrar

et al. 2004

Cancer

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BACKGROUNDTransjugular intrahepatic portosystemic shunt (TIPS) placement has emerged as an effective and minimally invasive method of treating portal hypertension and its associated complications. To the authors' knowledge there is limited documentation of its use for percutaneous shunting in patients with hepatic and extrahepatic malignancies. The current study reports the authors' experience with TIPS in the oncology setting.METHODSThirty‐eight patients with cancer underwent TIPS procedures. Nineteen patients had a history of hepatic malignancy. All medical records and imaging studies were reviewed retrospectively. The indication for TIPS, the presence of malignancy, procedural details, complications, survival, and treatment success were assessed.RESULTSPrimary technical success was accomplished in 37 of 38 patients (97%) without technical procedure‐related complications. Hepatic encephalopathy occurred in 15 of 34 patients (44%), with 3 patients requiring shunt reduction. Premature shunt occlusion (< 30 days) occurred in 3 patients (8%). Recurrent hemorrhage occurred in 1 of 19 patients (5%), and ascites and hepatic hydrothorax resolved or improved subjectively in 9 of 12 patients (75%). Shunts traversed malignancy in 9 patients, and varying degrees of portal compromise were encountered in 12 patients (32%). The overall 30‐day and 90‐day survival rates were 84% and 60%, respectively. There was a statistically significant difference in 90‐day survival rates for patients who had ascites and hepatic hydrothorax indications (27%) compared with patients who had variceal and portal gastropathy indications (84%; P = 0.0075). In addition, the 90‐day survival rate was significantly lower in patients who had primary hepatic malignancies (36%) compared with the remainder of the study population (74%; P = 0.0077), and it was significantly lower in patients who had model for end‐stage liver disease (MELD) scores ≥ 12 (P = 0.0020).CONCLUSIONSTIPS was performed safely for patients with cancer without increasing rates of procedure‐related complications. However, some patients subgroups, such at those with malignancy and ascites, primary hepatic malignancy, or MELD scores ≥ 12, had the lowest 90‐day survival rates. Cancer 2004. © 2004 American Cancer Society.

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“…This is most evident during the insertion of a TIPS shunt or in the immediate post-liver transplant period. Indeed, cardiac complications have been reported following TIPS insertion [82,83]. Huonker and colleagues [84] reported almost doubling of pulmonary wedge pressure and total pulmonary vascular resistance 90 min after a successful TIPS insertion, Fig.…”

Section: Clinical Presentations and Consequences Of Cirrhotic Cardiommentioning

confidence: 99%

Cirrhotic cardiomyopathy

2008

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Cirrhotic cardiomyopathy is a recently recognized condition in cirrhosis consisting of systolic incompetence under condition of stress, diastolic dysfunction related to altered diastolic relaxation, and electrophysiological abnormalities in the absence of any known cardiac disease. It can be diagnosed by using a combination of electrocardiograph, 2-dimensional echocardiography, and various serum markers such as brain natriuretic factor. The underlying pathogenetic mechanisms include abnormalities in the b-adrenergic signaling pathway, altered cardiomyocyte membrane fluidity, increased myocardial fibrosis, cardiomyocyte hypertrophy, and ion channel defects. Various compounds for which levels are elevated in cirrhosis such as nitric oxide and carbon monoxide can also exert a negative inotropic effect on the myocardium, whereas excess sodium and volume retention can lead to myocardial hypertrophy. Various toxins can also aggravate the ion channel defects, thereby widening the QRS complex causing prolonged QT intervals. Clinically, systolic incompetence is most evident when cirrhotic patients are placed under stress, whether physical or pharmacological, or when the extent of peripheral arterial vasodilatation demands an increased cardiac output as in the case of bacterial infections. Acute volume overload such as immediately after insertion of a transjugular intrahepatic portosystemic shunt or after liver transplantation can also tip these cirrhotic patients into cardiac failure. Treatment of cirrhotic cardiomyopathy is unsatisfactory. There is some evidence that b-blockade may help some cirrhotic patients with baseline prolonged QT interval. Long-term aldosterone antagonism may help reduce myocardial hypertrophy. Future studies should include further elucidation of pathogenetic mechanisms so as to develop effective treatment strategies.

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Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis

Cited by 501 publications

References 20 publications

Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study

Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Cirrhotic cardiomyopathy

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