Usefulness of peritoneo-venous shunt (denver shunt) for tolvaptan-resistant refractory ascites in patients with cirrhosis

Abstract

A Denver shunt, a peritoneo-venous shunt, is a devise to shunt ascites to the superior vena cava in patients showing refractory ascites. In the present study, efficacy and safety of a Denver shunt for patients with decompensated cirrhosis manifesting tolvaptan-resistant intractable ascites were evaluated. Subjects were 7 patients with cirrhosis in whom Denver shunt construction was done for intractable ascites in our institution from 2014 to 2018. Improvement of ascites-related symptoms was seen in 4 patients (57%), while decrease of ascites volume evaluated based on body weights and/or CT/MRI images was achieved in 5 patients (71%). Repeated drainage for ascites was discontinued in 2 patients (29%) and doses of diuretics were reduced in 5 patients (71%). Consequently, the overall response rate, fulfilling either of these criteria. was calculated as 86% In contrast, disseminated intravascular coagulation (DIC), wound divergence, spontaneous bacterial peritonitis, hepatic encephalopathy, and right heart failure occurred as adverse events following the procedure in 3, 1, 1, 1 and 1 patient(s), respectively, but the extents of DIC were none-severe in all patients and other events were attenuated following the conservative treatment. One patient died 30 days after the procedure due to liver failure without decrease of ascites. A Denver shunt was useful to attenuate refractory ascites in patients with decompensated cirrhosis even in those showing resistance against conventional therapies including tolvaptan.