Clinical response after transjugular intrahepatic portosystemic stent shunt insertion for refractory ascites in cirrhosis

Background: Transjugular intrahepatic portosystemic stent shunts (TIPSS) have been used successfully to reduce portal pressure in the context of variceal haemorrhage. Recent interest has focused on the possible use of TIPSS to manage refractory ascites. Aim: To study the effect of TIPSS insertion in 18 patients with refractory ascites. Results: Response rates were 33.3%, 50%, 33.3% and 26.7% at 1 week, 4 weeks, 3 months and 6 months, respectively. Overall mortality was 50% with a new or worsening encephalopathy rate also of 50%. Patients with lower serum bilirubin and serum creatinine prior to TIPSS insertion had greater response at 1 and 4 weeks, respectively. There was no improvement in either liver or renal function after TIPSS insertion by standard laboratory tests, although serum sodium increased in the responders after 1 month. Conclusion: TIPSS improves refractory ascites in only a minority of patients, and is associated with high encephalopathy and mortality rates