MIAMI BEACH — Transjugular intrahepatic portosystemic shunt placement remains an effective treatment for ascites in select patients, Dr. Florence Wong said at a meeting on hepatobiliary disease sponsored by the University of Miami.
The treatment, commonly known as TIPS, has been shown to significantly improve urinary sodium excretion by eliminating portal hypertension, explained Dr. Wong, of the University of Toronto.
In studies of TIPS in patients with this complication of cirrhosis, urinary sodium excretion has been shown to improve gradually over 14 months without the use of diuretic therapy, she noted.
Additionally, five randomized controlled trials comparing TIPS with repeat large-volume paracentesis showed that TIPS was better for controlling ascites.
A recent meta-analysis using individual patient data points shows a survival advantage for TIPS, compared with large-volume paracentesis, said Dr. Wong, who has submitted the meta-analysis data for publication.
But TIPS is not appropriate for all patients. The studies show that outcomes are worse with increasing age and with cardiac or renal dysfunction at baseline. Renal excretion of sodium tends to worsen with increasing age and baseline renal dysfunction, as well as in those with preexisting cardiac or coronary disease, she explained.
Furthermore, patients with a history of hepatic encephalopathy tend to have worsening of the condition following TIPS.
“We also now know that in those with more severe liver disease, with shunting the liver becomes mildly ischemic, and by placing TIPS, we may actually precipitate liver failure,” Dr. Wong said.
TIPS can be considered in those under age 65 with normal cardiac and renal function, and without a history of hepatic encephalopathy or severe liver disease, she said.