1998 Volume 95 Issue 3 Pages 221-229
Five cirrhotic patients with refractory ascites were treated with transjugular intrahepatic portosystemic shunt (TIPS). Before TIPS, although patients were received salt restriction (5g/day), diuretic therapy (furosemide 112mg/day, spironolactone 140mg/day), albumin infusion and paracentesis, ascites did not show improvement. After TIPS, urine volume and urinary sodium excretion increased significantly. Mean body weight decreased significantly from 73kg before TIPS to 63kg a month after TIPS. Improvement of ascites after TIPS were associated with a significant reduction in the dose of diuretics. On discharge, complete resolution of ascites was found in 2 patients and mild ascites remained in 3 other patients. Four patients presented 6 episodes of shunt stenosis in the follow-up period, and were treated with balloon dilatation. Ascites increased on shunt dysfunction and showed improvement after balloon dilatation. Post-TIPS encephalopathy was seen in 2 patients and one of 2 was disabled.
In conclusion, although post-TIPS shunt dysfunction and encephalopathy are common, TIPS is an effective therapy for refractory ascites in patients with cirrhosis.