R C Gaba1, A Parvinian2, L C Casadaban2, P M Couture2, S P Zivin3, J Lakhoo2, J Minocha3, C E Ray3, M G Knuttinen3, J T Bui3. 1. Department of Radiology, Division of Interventional Radiology, USA. Electronic address: rgaba@uic.edu. 2. University of Illinois College of Medicine, University of Illinois Hospital and Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA. 3. Department of Radiology, Division of Interventional Radiology, USA.
Abstract
AIM: To compare the impact of covered stent-graft transjugular intrahepatic portosystemic shunt (TIPS) versus serial paracentesis on survival of patients with medically refractory ascites. MATERIALS AND METHODS: In this retrospective study, cirrhotic patients who underwent covered stent-graft TIPS for refractory ascites from 2003-2013 were compared with similar patients who underwent serial paracentesis during 2009-2013. Demographic and liver disease data, Model for End-Stage Liver Disease (MELD) scores, and survival outcomes were obtained from hospital electronic medical records and the social security death index. After propensity score weighting to match study group characteristics, survival outcomes were compared using Kaplan-Meier statistics with log-rank analysis. RESULTS: Seventy TIPS (70% men, mean age 55.7 years, mean MELD 15.1) and 80 paracentesis (58% men, mean age 53.5 years, mean MELD 22.5) patients were compared. The TIPS haemodynamic success rate was 100% (mean portosystemic pressure gradient reduction 13 mmHg). Paracentesis patients underwent a mean of 7.9 procedures. After propensity score weighting to balance group features, TIPS patients showed a trend toward enhanced survival compared with paracentesis patients (median survival 1037 versus 262 days, p = 0.074). TIPS conferred a significant increase or trend toward improved survival compared with paracentesis at 1 (66% versus 44%, p = 0.018), 2 (56% versus 38%, p = 0.057), and 3 year (49% versus 32%, p = 0.077) time points. Thirty and 90 day mortality rates were not statistically increased by TIPS. CONCLUSION: Covered stent-graft TIPS improves intermediate- to long-term survival without significantly increasing short-term mortality of ascites patients, and suggests a greater potential role for TIPS in properly selected ascitic patients when medical management fails.
AIM: To compare the impact of covered stent-graft transjugular intrahepatic portosystemic shunt (TIPS) versus serial paracentesis on survival of patients with medically refractory ascites. MATERIALS AND METHODS: In this retrospective study, cirrhoticpatients who underwent covered stent-graft TIPS for refractory ascites from 2003-2013 were compared with similar patients who underwent serial paracentesis during 2009-2013. Demographic and liver disease data, Model for End-Stage Liver Disease (MELD) scores, and survival outcomes were obtained from hospital electronic medical records and the social security death index. After propensity score weighting to match study group characteristics, survival outcomes were compared using Kaplan-Meier statistics with log-rank analysis. RESULTS: Seventy TIPS (70% men, mean age 55.7 years, mean MELD 15.1) and 80 paracentesis (58% men, mean age 53.5 years, mean MELD 22.5) patients were compared. The TIPS haemodynamic success rate was 100% (mean portosystemic pressure gradient reduction 13 mmHg). Paracentesis patients underwent a mean of 7.9 procedures. After propensity score weighting to balance group features, TIPS patients showed a trend toward enhanced survival compared with paracentesis patients (median survival 1037 versus 262 days, p = 0.074). TIPS conferred a significant increase or trend toward improved survival compared with paracentesis at 1 (66% versus 44%, p = 0.018), 2 (56% versus 38%, p = 0.057), and 3 year (49% versus 32%, p = 0.077) time points. Thirty and 90 day mortality rates were not statistically increased by TIPS. CONCLUSION: Covered stent-graft TIPS improves intermediate- to long-term survival without significantly increasing short-term mortality of ascitespatients, and suggests a greater potential role for TIPS in properly selected asciticpatients when medical management fails.
Authors: G Stirnimann; T Berg; L Spahr; S Zeuzem; S McPherson; F Lammert; F Storni; V Banz; J Babatz; V Vargas; A Geier; A Stallmach; C Engelmann; C Trepte; J Capel; A De Gottardi Journal: Aliment Pharmacol Ther Date: 2017-09-21 Impact factor: 8.171
Authors: Thomas Reiberger; Andreas Püspök; Maria Schoder; Franziska Baumann-Durchschein; Theresa Bucsics; Christian Datz; Werner Dolak; Arnulf Ferlitsch; Armin Finkenstedt; Ivo Graziadei; Stephanie Hametner; Franz Karnel; Elisabeth Krones; Andreas Maieron; Mattias Mandorfer; Markus Peck-Radosavljevic; Florian Rainer; Philipp Schwabl; Vanessa Stadlbauer; Rudolf Stauber; Herbert Tilg; Michael Trauner; Heinz Zoller; Rainer Schöfl; Peter Fickert Journal: Wien Klin Wochenschr Date: 2017-10-23 Impact factor: 1.704
Authors: Dhiraj Tripathi; Adrian J Stanley; Peter C Hayes; Simon Travis; Matthew J Armstrong; Emmanuel A Tsochatzis; Ian A Rowe; Nicholas Roslund; Hamish Ireland; Mandy Lomax; Joanne A Leithead; Homoyon Mehrzad; Richard J Aspinall; Joanne McDonagh; David Patch Journal: Gut Date: 2020-02-29 Impact factor: 23.059