REFRACTORY ASCITES - EARLY EXPERIENCE IN TREATMENT WITH TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

PURPOSE: To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) in treatment of refractory ascites. MATERIALS AND METHODS: Fou rteen patients with chronic liver disease and portal hypertension were included in a prospective study. Six patients had Child-Pugh class B disease; eight had class C disease. Indications for TIPS were three pr evious hospital admissions over 9 months for treatment of tense ascite s, no response to diuretic therapy, or an occluded peritoneovenous shu nt with tense ascites. The volume of ascitic fluid was sonographically evaluated before and after TIPS placement. RESULTS: The technical suc cess rate for TIPS creation was 93%. Mean portosystemic gradient decre ased from 22.8 mm Hg +/- 7.2 before TIPS placement to 11.3 mm Hg +/- 3 .6 after TIPS (P = .005). Complete resolution of ascites was achieved in seven (50%) patients. Treatment failed in seven; five had Child-Pug h class C disease, and four of these had a Child-Pugh score greater th an 11. CONCLUSION: These results are comparable to those for other for ms of treatment of ascites. The authors do not, however, recommend TIP S in patients with a Child-Pugh score greater than 11.