PT  - JOURNAL ARTICLE
AU  - Kota Tsuruya
AU  - Jun Koizumi
AU  - Yuka Sekiguchi
AU  - Shun Ono
AU  - Tatsuya Sekiguchi
AU  - Takuya Hara
AU  - Yusuke Mishima
AU  - Yoshitaka Arase
AU  - Shunji Hirose
AU  - Koichi Shiraishi
AU  - Tatehiro Kagawa
TI  - First reports of clinical effects of transjugular intrahepatic portosystemic shunt in four patients with cirrhotic ascites refractory to tolvaptan
AID  - 10.1136/bmjgast-2023-001120
DP  - 2023 Apr 01
TA  - BMJ Open Gastroenterology
PG  - e001120
VI  - 10
IP  - 1
4099  - http://bmjopengastro.bmj.com//content/10/1/e001120.short
4100  - http://bmjopengastro.bmj.com//content/10/1/e001120.full
SO  - BMJ Open Gastro2023 Apr 01; 10
AB  - 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.Data are available upon reasonable request.