Published online Sep 28, 2017. doi: 10.4254/wjh.v9.i27.1125
Peer-review started: February 7, 2017
First decision: April 1, 2017
Revised: July 20, 2017
Accepted: September 5, 2017
Article in press: September 5, 2017
Published online: September 28, 2017
To prospectively evaluate the performance of Doppler-ultrasonography (US) for the detection of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction within a multicenter cohort of cirrhotic patients.
This study was conducted in 10 french teaching hospitals. After TIPS insertion, angiography and liver Doppler-US were carried out every six months to detect dysfunction (defined by a portosystemic gradient ≥ 12 mmHg and/or a stent stenosis ≥ 50%). The association between ultrasonographic signs and dysfunction was studied by logistic random-effects models, and the diagnostic performance of each Doppler criterion was estimated by the bootstrap method. This study was approved by the ethics committee of Tours.
Two hundred and eighteen pairs of examinations performed on 87 cirrhotic patients were analyzed. Variables significantly associated with dysfunction were: The speed of flow in the portal vein (P = 0.008), the reversal of flow in the right (P = 0.038) and left (P = 0.049) portal branch, the loss of modulation of portal flow by the right atrium (P = 0.0005), ascites (P = 0.001) and the overall impression of the operator (P = 0.0001). The diagnostic performances of these variables were low; sensitivity was < 58% and negative predictive value was < 73%. Therefore, dysfunction cannot be ruled out from Doppler-US.
The performance of Doppler-US for the detection of TIPS dysfunction is poor compared to angiography. New tools are needed to improve diagnosis of TIPS dysfunction.
Core tip: This large multicentric prospective study evaluates the performance of Doppler-ultrasonography (US) for the detection of transjugular intrahepatic portosystemic shunt dysfunction within a cohort of cirrhotic patients. Although many Doppler-US variables were significantly associated with dysfunction, the diagnostic performances of these variables were low compared to angiography.