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TIPS reduces the rate of ascites recurrence mainly due to the reduction in the filtration pressure. In addition, TIPS results in a positive effect on renal function, including hepatorenal syndrome, demonstrated by a rapid increase in urinary sodium excretion, urinary volume, and improvement in plasma creatinine concentration. Furthermore, plasma renin activity, aldosterone, and noradrenalin concentrations improve gradually after TIPS insertion suggesting a positive effect on systemic underfilling, the factor of hepatorenal syndrome. As demonstrated recently in two meta-analyses including five randomised studies, TIPS also improves survival when compared with paracentesis. However, the evidence is based on relatively few studies with only 305 patients included. The positive effects of the TIPS are opposed by an increased frequency and severity of episodes of hepatic encephalopathy which may be reduced by both patient selection and reduced shunt diameter. Based on the present knowledge the recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates.<\/jats:p>","DOI":"10.1136\/gut.2009.193227","type":"journal-article","created":{"date-parts":[[2010,6,25]],"date-time":"2010-06-25T13:46:09Z","timestamp":1277473569000},"page":"988-1000","source":"Crossref","is-referenced-by-count":191,"title":["TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update"],"prefix":"10.1136","volume":"59","author":[{"given":"Martin","family":"R\u00f6ssle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander L","family":"Gerbes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2010,6,25]]},"reference":[{"key":"2025090715075448000_59.7.988.1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510230122"},{"issue":"Suppl 6","key":"2025090715075448000_59.7.988.2","first-page":"1","article-title":"Guidelines on the management of ascites in cirrhosis","volume":"55","author":"Moore","year":"2006","journal-title":"Gut"},{"key":"2025090715075448000_59.7.988.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2006.12.001"},{"key":"2025090715075448000_59.7.988.4","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2006.107789"},{"key":"2025090715075448000_59.7.988.5","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S1665-2681(19)31831-9","article-title":"Hepatic hydrothorax: current concepts of pathophysiology and treatment options","volume":"7","author":"Kiafar","year":"2008","journal-title":"Ann Hepatol"},{"key":"2025090715075448000_59.7.988.6","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/0016-5085(87)91007-9","article-title":"Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites: results of a randomised study","volume":"93","author":"Gines","year":"1987","journal-title":"Gastroenterology"},{"key":"2025090715075448000_59.7.988.7","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20317"},{"key":"2025090715075448000_59.7.988.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)92927-2"},{"key":"2025090715075448000_59.7.988.9","first-page":"406","article-title":"Der transjugulare intrahepatische portosystemische Stent-Shunt (TIPSS). 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