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. 2023 Apr;10(1):e001120.
doi: 10.1136/bmjgast-2023-001120.

First reports of clinical effects of transjugular intrahepatic portosystemic shunt in four patients with cirrhotic ascites refractory to tolvaptan

Kota Tsuruya  1 , Jun Koizumi  2   3 , Yuka Sekiguchi  2 , Shun Ono  2 , Tatsuya Sekiguchi  2 , Takuya Hara  2 , Yusuke Mishima  4 , Yoshitaka Arase  4 , Shunji Hirose  4 , Koichi Shiraishi  4 , Tatehiro Kagawa  4
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First reports of clinical effects of transjugular intrahepatic portosystemic shunt in four patients with cirrhotic ascites refractory to tolvaptan

Kota Tsuruya et al. BMJ Open Gastroenterol. 2023 Apr.

Abstract

Objective: Ascites in patients with decompensated cirrhosis can lead to abdominal distention and decrease quality of life. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective agent in the treatment of ascites, whereas some patients are refractory to tolvaptan. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for these patients is not known. In this study, we performed TIPS for tolvaptan-refractory cirrhotic patients and analysed its efficacy and safety in these patients.

Design: This retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS.

Results: This study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m2 in a month after TIPS procedure.

Conclusion: TIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.

Keywords: ASCITES; INTERVENTIONAL RADIOLOGY; LIVER CIRRHOSIS; PORTAL HYPERTENSION.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Abdominal computed tomography scan images before TIPS creation. (A) Case 1, (B) case 2, (C) case 3 and (D) case 4. TIPS, transjugular intrahepatic portosystemic shunt.
Figure 2
Figure 2
Abdominal computed tomography scan images post TIPS creation. (A) Case 1, (B) Case 2, (C) case 3 and (D) case 4. TIPS, transjugular intrahepatic portosystemic shunt.
See this image and copyright information in PMC

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