studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 347A
263
TIPS with PTFE-covered stent improves liver transplant
free survival in patients with cirrhosis and recurrent
ascites : results of a multicentre randomized trial
Christophe Bureau 1,2 , Dominique Thabut 3 , Frederic Oberti 4 ,
Sebastien Dharancy 5 , Pauline Cabarrou 1 , Nicolas Carbonell 3 ,
Antoine Bouvier 4 , Philippe Mathurin 5 , Philippe Otal 1 , Jean-Marie
Peron 1,2 , Jean-Pierre Vinel 1,2 ; 1 Service d’Hépatogastroenterologie,
CHU Toulouse, Toulouse, France; 2 Université Paul Sabatier,
Toulouse, France; 3 APHP, Paris, France; 4 CHU Angers, Angers,
France; 5 CHRU Lille, Lille, France
Introduction Transjugular intrahepatic portosystemic shunt
(TIPS) proved to be effective in the treatment of refractory ascites.
However, its impact on survival remains controversial. The
high rate of shunt dysfunction with the use of uncovered stents
could attenuate the beneficial effects of TIPS. It has been shown
that the use of PTFE covered stents decreases the risk of shunt
dysfunction and improves clinical outcome. The main objective
was to compare the liver transplantation free survival of
cirrhotic patients and recurrent ascites between those treated
by covered TIPS and those treated by large volume paracentesis
+ albumin infusion (P+A). Methods Between august 2005
and november 2012, all cirrhotic patients with at least two
large volume paracentesis were considered for inclusion. The
main end point was 1-year liver transplantation free survival.
Secondary end points were the rates of: ascites recurrence
and treatment failure, overt hepatic encephalopathy and portal
hypertension (PHT) related complications; and the number of
days in hospitalization over a 1-year period after inclusion.
Results 62 patients were included (29 in TIPS group and 33 in
P+A group). The baseline characteristics of the patients were
similar in both groups. The median follow up of the whole
cohort was 365 days. One patient in each group was lost to
follow up. Actuarial rates of transplantation free survival was
better in TIPS group compared to that observed in the P+A
group: 93 % [IC 95 % 82%-100 %] and 52 % [IC 95 % 34%-
60 %], respectively (p=0.003). During the 1-year of follow
up, the total number of paracentesis was 32 (1.0 ± 1.6 per
patient) in TIPS group and 320 in P+A (10.1 ± 7.0 per patient).
Total albumin infusion was 2061 g in TIPS group compared to
17727 g in P+A group. In P+A group, 15 patients were treated
by TIPS during follow up, 14 because of the need of more than
6 large volume paracentesis within less than 3 months and 1
because of associated recurrent variceal bleeding. The 1-year
probability of remaining free of encephalopathy was 65 %
in both groups. The rates of PHT related bleeding and hernia
related complications were significantly higher in P+A group.
The number of days in hospitalizations was doubled in P+A
group compared to TIPS group (17 ± 28 vs 35 ± 40 p = 0.04).
Conclusion: the use of covered TIPS in selected patients with
recurrent ascites improved transplant free survival as compared
to patients treated by repeated large volume paracentesis +
albumin infusion.
Disclosures:
Christophe Bureau - Grant/Research Support: Gore; Speaking and Teaching:
Gore
Frederic Oberti - Stock Shareholder: Bio Live Scale
Sebastien Dharancy - Advisory Committees or Review Panels: CHIESI; Board
Membership: NOVARTIS; Speaking and Teaching: ASTELLAS
Philippe Mathurin - Board Membership: MSD, Janssen-Cilag, BMS, Gilead,
Abvie, Oncozyme; Consulting: Roche, Bayer
Jean-Marie Peron - Board Membership: BAYER; Consulting: BMS, GILEAD, BOS-
TON SCIENTIFIC
Jean-Pierre Vinel - Grant/Research Support: Roche, Gore, LFB
The following authors have nothing to disclose: Dominique Thabut, Pauline
Cabarrou, Nicolas Carbonell, Antoine Bouvier, Philippe Otal
264
Diagnostic accuracy of the Periscreen TM reagent strip
in diagnosis of spontaneous bacterial peritonitis in cirrhotic
patients (PerDRISLA study)
Thierry Thevenot 1 , Charline Briot 1 , Vincent Macé 2,22 , Hortensia
Lison 3 , Laure Elkrief 4 , Alexandra Heurgué-Berlot 5 , Christophe
Bureau 6 , Caroline Jezequel 7 , Ghassan Riachi 8 , Alexandre Louvet
9 , Isabelle Ollivier-Hourmand 10 , Hélène Labadie 11 , Nicolas
Carbonell 12 , Karim Aziz 13 , Denis Grasset 14 , Rodolphe Anty 15 ,
Eric Nguyen-Khac 16 , Mehdi Kaasis 17 , Thomas Mouillot 18 , Arnaud
Pauwels 19 , Florence Tanné 20 , Si Nafa Si Ahmed 21 , Jean Paul
Cervoni 1 , Jean françois D. Cadranel 3 , Matthieu Schnee 2 ; 1 Hepatogastroenterology,
CHU Minjoz, Besançon, France; 2 Hepatogastroenterology,
CHD-Vendée, La Roche sur Yon, France;
3 Hepatogastroenterology, Höpital Laennec, Creil, France; 4 Hepatology,
CHU- Beaujon, Clichy, France; 5 Hepatogastroenterology,
CHU Reims, Reims, France; 6 Hepatogastroenterology, CHU Purpan,
Toulouse, France; 7 Hepatogastroenterology, CHU Pontchaillou,
Rennes, France; 8 Hepatogastroenterology, CHU Charles
Nicolle, Rouen, France; 9 Hepatology, CHU Claude Huriez, Lille,
France; 10 Hepatogastroenterology, CHU Caen, Caen, France;
11 Hepatogastroenterology, CH de Saint-Denis, Saint-Denis,
France; 12 Hepatogastroenterology, Hôpital Saint-Antoine, Paris,
France; 13 Hepatogastroenterology, CH de Saint-Brieuc, Saint-
Brieuc, France; 14 Hepatogastroenterology, CH Bretagne-Atlantique,
Vannes, France; 15 Hepatogastroenterology, CHU Archet,
Nice, France; 16 Hepatogastroenterology, CHU Amiens, Amiens,
France; 17 Hepatogastroenterology, CH de Cholet, Cholet, France;
18 Hepatogastroenterology, Hôpital du Bocage, Dijon, France;
19 Hepatogastroenterology, CH de Gonesse, Gonesse, France;
20 Hepatogastroenterology, CHU La-Cavale-Blanche, Brest, France;
21 Hepatogastroenterology, CHR d’Orléans, Orléans, France;
22 Hepatogastroenterology, CHU de Nantes, Nantes, France
Background & Aim: The diagnostic accuracy of spontaneous
bacterial peritonitis (SBP) using reagent strips is currently disappointing
(1) but an experimental work using the Periscreen
TM strip was more optimistic (2). We aim to assess the
performance of the Periscreen TM strip for the diagnosis of SBP.
Methods: This study involved all consecutive cirrhotic patients
with ascites between June 2014 and March 2015 among
22 French centers. Ascitic fluid was tested independently by
two investigators using Periscreen TM at 3 minutes as reported
(2). The strip has 4 colorimetric graduations (negative, trace,
small or large). The diagnosis of SBP was based on neutrophils
>250/mm 3 , regardless the culture of ascites. We excluded
bloody, chylous or bilious ascitic fluid, or concurrent imipenem
treatment. Results: The characteristics of the 387 cirrhotic
patients included were: mean age 61.9±10.4 years, 75.4%
males, 73.1% alcohol, mean Child-Pugh 9.6 (range: 6-15). A
total of 1190 paracenteses were analyzed: 468 (39.3%) were
collected in patients hospitalized for an acute decompensation
of cirrhosis and 722 (60.7%) in outpatients. For inter-investigator
agreement, the Kappa value was 0.79 (IC95%: 0.76-
0.83). A total of 72 (5.8%) samples had SBP, 58 in inpatient
(11.5%) and 14 (1.9%) in outpatient setting (P