A Comparison of Paracentesis and Transjugular Intrahepatic Portosystemic Shunting in Patients with Ascites

• Published in: The New England journal of medicine Vol. 342; no. 23; pp. 1701 - 1707
• Main Authors: Rössle, Martin, Ochs, Andreas, Gülberg, Veit, Siegerstetter, Volker, Holl, Joseph, Deibert, Peter, Olschewski, Manfred, Reiser, Maximilian, Gerbes, Alexander L
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 08.06.2000
• Subjects: Adult; Aged; Ascites - etiology; Ascites - mortality; Ascites - therapy; Female; Hepatic Encephalopathy - etiology; Humans; Kidney - physiopathology; Liver cirrhosis; Liver Cirrhosis - complications; Liver Transplantation; Male; Medical research; Middle Aged; Multivariate Analysis; Paracentesis; Portasystemic Shunt, Transjugular Intrahepatic; Proportional Hazards Models; Prospective Studies; Recurrence; Survival Analysis
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM200006083422303

Refractory or recurrent ascites is a clinical challenge frequently encountered in patients with cirrhosis. 1 – 3 The treatment options are repeated large-volume paracentesis, creation of a peritoneovenous shunt, creation of a portosystemic shunt, and liver transplantation. Elevated portal-vein pressure is a main factor in the pathogenesis of ascites. A reduction in pressure by means of the surgical creation of a portosystemic shunt 4 – 6 or transjugular intrahepatic portosystemic shunt 7 – 15 has been shown to be followed by decreased formation of ascites. With the exception of a small, randomized study 16 that found an increased rate of death among patients with ascites who were . . .