What is the role of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cirrhosis?

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

Answer

A TIPS is an effective tool in managing massive ascites in some patients. Ideally, TIPS placement produces a decrease in sinusoidal pressure and in plasma renin and aldosterone levels, with subsequent improved urinary sodium excretion. In one study, 74% of patients with refractory ascites achieved complete remission of ascites within 3 months of TIPS placement. [26] Typically, about one half of appropriately selected patients undergoing TIPS achieve significant relief of ascites.

Multiple studies have demonstrated that TIPS is superior to large-volume paracentesis when it comes to the control of ascites. [27] One meta-analysis of individual patient data demonstrated an improvement in transplant-free life expectancy in patients whose massive ascites was treated with a TIPS, as opposed to large-volume paracentesis. [28] However, the creation of a TIPS has the potential to worsen preexisting hepatic encephalopathy and exacerbate liver dysfunction in patients with severe, underlying liver failure. [29]


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