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Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta‐analysis
Author(s) -
Deltenre P.,
Mathurin P.,
Dharancy S.,
Moreau R.,
Bulois P.,
Henrion J.,
Pruvot F. R.,
Ernst O.,
Paris J. C.,
Lebrec D.
Publication year - 2005
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2005.01095.x
Subject(s) - medicine , ascites , hepatic encephalopathy , transjugular intrahepatic portosystemic shunt , confidence interval , gastroenterology , paracentesis , encephalopathy , randomized controlled trial , portal hypertension , surgery , cirrhosis
Transjugular intrahepatic portosystemic shunt (TIPS) is a more effective treatment for refractory ascites than large volume paracentesis (LVP), but the magnitude of its effect in terms of control of ascites, encephalopathy and survival has not been established. Aim: This meta‐analysis compare TIPS to LVP in terms of control of ascites at 4 and 12 months, encephalopathy and survival at 1 and 2 years. Results: Five randomized controlled trials involving 330 patients were included. In the TIPS group, control of ascites was more frequently achieved at 4 months (66% vs 23.8%, mean difference: 41.4%, 95% confidence interval (CI): 29.5–53.2%, P <0.001) and 12 months (54.8% vs 18.9%, mean difference: 35%, 95% CI: 24.9–45.1%, P <0.001), whereas encephalopathy was higher (54.9% vs 38.1%, mean difference: 17%, 95% CI: 7.3–26.6%, P <0.001). Survival at 1 year (61.7% vs 56.5%, mean difference: 3.2%, 95% CI: −14.7 to 21.9%) and 2 years (50% vs 42.8%, mean difference: 6.8%, 95% CI: −10 to 23.6%) were not significantly different. Conclusions: TIPS is a more effective treatment for refractory ascites than LVP. However, TIPS increase encephalopathy and does not improve survival.