A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites - PubMed (original) (raw)
Clinical Trial
. 2000 Jun 8;342(23):1701-7.
doi: 10.1056/NEJM200006083422303.
Affiliations
- PMID: 10841872
- DOI: 10.1056/NEJM200006083422303
Free article
Clinical Trial
A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites
M Rössle et al. N Engl J Med. 2000.
Free article
Abstract
Background: In patients with cirrhosis and ascites, creation of a transjugular intrahepatic portosystemic shunt may reduce the ascites and improve renal function. However, the benefit of this procedure as compared with that of large-volume paracentesis is uncertain.
Methods: We randomly assigned 60 patients with cirrhosis and refractory or recurrent ascites (Child-Pugh class B in 42 patients and class C in 18 patients) to treatment with a transjugular shunt (29 patients) or large-volume paracentesis (31 patients). The mean (+/-SD) duration of follow-up was 45+/-16 months among those assigned to shunting and 44+/-18 months among those assigned to paracentesis. The primary outcome was survival without liver transplantation.
Results: Among the patients in the shunt group, 15 died and 1 underwent liver transplantation during the study period, as compared with 23 patients and 2 patients, respectively, in the paracentesis group. The probability of survival without liver transplantation was 69 percent at one year and 58 percent at two years in the shunt group, as compared with 52 percent and 32 percent in the paracentesis group (P=0.11 for the overall comparison, by the log-rank test). In a multivariate analysis, treatment with transjugular shunting was independently associated with survival without the need for transplantation (P=0.02). At three months, 61 percent of the patients in the shunt group and 18 percent of those in the paracentesis group had no ascites (P=0.006). The frequency of hepatic encephalopathy was similar in the two groups. Of the patients assigned to paracentesis in whom this procedure was unsuccessful, 10 received a transjugular shunt a mean of 5.5+/-4 months after randomization; 4 had a response to this rescue treatment.
Conclusions: In comparison with large-volume paracentesis, the creation of a transjugular intrahepatic portosystemic shunt can improve the chance of survival without liver transplantation in patients with refractory or recurrent ascites.
Comment in
- The role of transjugular portosystemic shunting in patients with ascites.
Lake JR. Lake JR. N Engl J Med. 2000 Jun 8;342(23):1745-7. doi: 10.1056/NEJM200006083422311. N Engl J Med. 2000. PMID: 10841880 No abstract available.
Similar articles
- Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis.
Ginès P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, Del Arbol LR, Planas R, Bosch J, Arroyo V, Rodés J. Ginès P, et al. Gastroenterology. 2002 Dec;123(6):1839-47. doi: 10.1053/gast.2002.37073. Gastroenterology. 2002. PMID: 12454841 Clinical Trial. - Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites.
Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, Nicolini A, Salvatori F. Salerno F, et al. Hepatology. 2004 Sep;40(3):629-35. doi: 10.1002/hep.20364. Hepatology. 2004. PMID: 15349901 Clinical Trial. - The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites.
Ochs A, Rössle M, Haag K, Hauenstein KH, Deibert P, Siegerstetter V, Huonker M, Langer M, Blum HE. Ochs A, et al. N Engl J Med. 1995 May 4;332(18):1192-7. doi: 10.1056/NEJM199505043321803. N Engl J Med. 1995. PMID: 7700312 - Transjugular intrahepatic portosystemic shunt in the management of ascites and hepatorenal syndrome.
Senzolo M, Cholongitas E, Tibballs J, Burroughs A, Patch D. Senzolo M, et al. Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1143-50. doi: 10.1097/01.meg.0000236872.85903.3f. Eur J Gastroenterol Hepatol. 2006. PMID: 17033432 Review. - Management of ascites in cirrhosis.
Sandhu BS, Sanyal AJ. Sandhu BS, et al. Clin Liver Dis. 2005 Nov;9(4):715-32, viii. doi: 10.1016/j.cld.2005.07.008. Clin Liver Dis. 2005. PMID: 16207572 Review.
Cited by
- Effects of Transjugular Intrahepatic Portosystemic Shunt on Renal and Pulmonary Function in Hepatic Decompensation with and without Hepatorenal and Hepatopulmonary Syndromes: A Review.
Abdelwahed AH, Aboeldahb M, Wu GY. Abdelwahed AH, et al. J Clin Transl Hepatol. 2024 Sep 28;12(9):780-791. doi: 10.14218/JCTH.2024.00188. Epub 2024 Jul 25. J Clin Transl Hepatol. 2024. PMID: 39280072 Free PMC article. Review. - Road to recompensation: Baveno VII criteria and transjugular intrahepatic portosystemic shunt in liver cirrhosis.
Anis MA, Majeed AA, Abid S. Anis MA, et al. World J Gastroenterol. 2024 Aug 28;30(32):3743-3747. doi: 10.3748/wjg.v30.i32.3743. World J Gastroenterol. 2024. PMID: 39221069 Free PMC article. - The Role of Transjugular Intrahepatic Portosystemic Shunt for the Management of Ascites in Patients with Decompensated Cirrhosis.
Iannone G, Pompili E, De Venuto C, Pratelli D, Tedesco G, Baldassarre M, Caraceni P, Zaccherini G. Iannone G, et al. J Clin Med. 2024 Feb 27;13(5):1349. doi: 10.3390/jcm13051349. J Clin Med. 2024. PMID: 38592162 Free PMC article. Review. - Recent developments in the management of ascites in cirrhosis.
Lan T, Chen M, Tang C, Deltenre P. Lan T, et al. United European Gastroenterol J. 2024 Mar;12(2):261-272. doi: 10.1002/ueg2.12539. Epub 2024 Feb 10. United European Gastroenterol J. 2024. PMID: 38340308 Free PMC article. Review. - Transjugular intrahepatic portosystemic shunts for adults with hepatorenal syndrome.
Gonzalez-Garay AG, Serralde-Zúñiga AE, Velasco Hidalgo L, Flores García NC, Aguirre-Salgado MI. Gonzalez-Garay AG, et al. Cochrane Database Syst Rev. 2024 Jan 18;1(1):CD011039. doi: 10.1002/14651858.CD011039.pub2. Cochrane Database Syst Rev. 2024. PMID: 38235907
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources