Luo SH, Zhang HF, Liu W, Chu JG, Chen JY. Comparison of clinical outcomes of transjugular intrahepatic portosystemic shunt for refractory ascites and recurrent nonrefractory ascites. World J Hepatol 2025; 17(2): 100451 [DOI: 10.4254/wjh.v17.i2.100451]
Corresponding Author of This Article
Jian-Yong Chen, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology and Hepatology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, No. 152 Aiguo Road, Donghu District, Nanchang 330006, Jiangxi Province, China. cjyacy69@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shi-Hua Luo, Hui-Fang Zhang, Jian-Yong Chen, Department of Gastroenterology and Hepatology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, Jiangxi Province, China
Wei Liu, Department of Gastroenterology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
Jian-Guo Chu, Department of Gastroenterology, Air Force Medical Center of PLA, Beijing 100142, China
Author contributions: Chu JG designed the research; Luo SH performed the research; Luo SH, Zhang HF, Liu W collected the data; Luo SH wrote the paper; Chen JY revised the paper; all authors have read and approved the final version to be submitted.
Institutional review board statement: All procedures were conducted according to the guidelines approved by the Ethics Committee of Air Force Medical Center of PLA (AB-17.05/06).
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Yong Chen, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology and Hepatology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, No. 152 Aiguo Road, Donghu District, Nanchang 330006, Jiangxi Province, China. cjyacy69@163.com
Received: August 16, 2024 Revised: December 4, 2024 Accepted: January 23, 2025 Published online: February 27, 2025 Processing time: 187 Days and 12.5 Hours
Abstract
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) has an important role in the therapy of complications of portal-hypertension-related ascites. Various guidelines now indicate that TIPS is indicated for refractory ascites (RA), but TIPS for recurrent nonrefractory ascites (RNRA) achieved better clinical results.
AIM
To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.
METHODS
There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021. In category 1, patients had ascites without cirrhotic gastrointestinal bleeding. The patients were divided into group A (RNRA, n = 183) and group B (RA, n = 217). In category 2, patients had ascites and cirrhotic gastrointestinal bleeding. The patients were divided into group C (RNRA, n = 328) and group D (RA, n = 135). The clinical outcomes were probability of total hepatic impairment, incidence of hepatic encephalopathy (HE) and mortality.
RESULTS
The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B (P = 0.032), and in group C compared with group D (P = 0.027). By the end of follow-up, there were significant differences in the rate of RA in group A compared with group B (P = 0.016), and in group C compared with group D (P = 0.012). The probability of total hepatic impairment was significantly different in group A compared with group B (P = 0.024), and in group C compared with group D (P = 0.019). The total incidence of HE was significantly different in group A compared with group B (P = 0.008), and in group C compared with group D (P = 0.004). The 6-month, and 1-, 2- and 3-year survival rates were significantly different between groups A and B (all P < 0.05), and between groups C and D (all P < 0.05).
CONCLUSION
TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension, and early TIPS for RNRA can prolong survival, and prevent progression to RA.
Core Tip: This study aims to retrospectively compare the clinical outcomes of patients with refractory ascites (RA) and recurrent nonrefractory ascites (RNRA) who underwent transjugular intrahepatic portosystemic shunt (TIPS) for complications related to portal hypertension. RA is associated with a significant reduced survival of 50% at 6 months, and is related to development of many complications. Quality of life is poor. TIPS is currently adopted for the treatment of cirrhotic portal hypertension combined with ascites in the absence of progression to RA, that is, at the stage of RNRA. As a result, liver function does not deteriorate, ascites does not recur, survival is prolonged, and quality of life is improved compared with patients with RA.
