{"title":"Comparison of clinical outcomes of transjugular intrahepatic portosystemic shunt for refractory ascites and recurrent nonrefractory ascites.","authors":"Shi-Hua Luo, Hui-Fang Zhang, Wei Liu, Jian-Guo Chu, Jian-Yong Chen","doi":"10.4254/wjh.v17.i2.100451","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Transjugular intrahepatic portosystemic shunt (TIPS) has an important role in the therapy of complications of portal-hypertension-related ascites. Various guidelines now indicate that TIPS is indicated for refractory ascites (RA), but TIPS for recurrent nonrefractory ascites (RNRA) achieved better clinical results.</p><p><strong>Aim: </strong>To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.</p><p><strong>Methods: </strong>There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021. In category 1, patients had ascites without cirrhotic gastrointestinal bleeding. The patients were divided into group A (RNRA, <i>n</i> = 183) and group B (RA, <i>n</i> = 217). In category 2, patients had ascites and cirrhotic gastrointestinal bleeding. The patients were divided into group C (RNRA, <i>n</i> = 328) and group D (RA, <i>n</i> = 135). The clinical outcomes were probability of total hepatic impairment, incidence of hepatic encephalopathy (HE) and mortality.</p><p><strong>Results: </strong>The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B (<i>P</i> = 0.032), and in group C compared with group D (<i>P</i> = 0.027). By the end of follow-up, there were significant differences in the rate of RA in group A compared with group B (<i>P</i> = 0.016), and in group C compared with group D (<i>P</i> = 0.012). The probability of total hepatic impairment was significantly different in group A compared with group B (<i>P</i> = 0.024), and in group C compared with group D (<i>P</i> = 0.019). The total incidence of HE was significantly different in group A compared with group B (<i>P</i> = 0.008), and in group C compared with group D (<i>P</i> = 0.004). The 6-month, and 1-, 2- and 3-year survival rates were significantly different between groups A and B (all <i>P</i> < 0.05), and between groups C and D (all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension, and early TIPS for RNRA can prolong survival, and prevent progression to RA.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 2","pages":"100451"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866158/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Hepatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4254/wjh.v17.i2.100451","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
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Abstract
Background: Transjugular intrahepatic portosystemic shunt (TIPS) has an important role in the therapy of complications of portal-hypertension-related ascites. Various guidelines now indicate that TIPS is indicated for refractory ascites (RA), but TIPS for recurrent nonrefractory ascites (RNRA) achieved better clinical results.
Aim: To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.
Methods: There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021. In category 1, patients had ascites without cirrhotic gastrointestinal bleeding. The patients were divided into group A (RNRA, n = 183) and group B (RA, n = 217). In category 2, patients had ascites and cirrhotic gastrointestinal bleeding. The patients were divided into group C (RNRA, n = 328) and group D (RA, n = 135). The clinical outcomes were probability of total hepatic impairment, incidence of hepatic encephalopathy (HE) and mortality.
Results: The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B (P = 0.032), and in group C compared with group D (P = 0.027). By the end of follow-up, there were significant differences in the rate of RA in group A compared with group B (P = 0.016), and in group C compared with group D (P = 0.012). The probability of total hepatic impairment was significantly different in group A compared with group B (P = 0.024), and in group C compared with group D (P = 0.019). The total incidence of HE was significantly different in group A compared with group B (P = 0.008), and in group C compared with group D (P = 0.004). The 6-month, and 1-, 2- and 3-year survival rates were significantly different between groups A and B (all P < 0.05), and between groups C and D (all P < 0.05).
Conclusion: TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension, and early TIPS for RNRA can prolong survival, and prevent progression to RA.
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