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Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites . Veterans Administration Cooperative Study on Treatment of Alcoholic Cirrhosis with Ascites . The optimal management of severe ascites in patients with alcoholic cirrhosis has not been defined . in a 5 1/2-year study , we randomly assigned 299 men with alcoholic cirrhosis , who had persistent or recurrent severe ascites despite a standard medical regimen , to receive either intensive medical treatment or peritoneovenous ( LeVeen ) shunting . We identified three risk groups : Group 1 had normal or mildly abnormal results on liver-function tests , Group 2 had more severe liver dysfunction or previous complications , and Group 3 had severe prerenal azotemia without kidney disease . For the patients who received the medical treatment and those who received the surgical treatment combined , the median survival times were 1093 days in Group 1 , 222 days in Group 2 , and 37 days in Group 3 ( P less than or equal to 0.01 ) for all comparisons ) . For all the groups combined , the median time to the resolution of ascites was 5.4 weeks for medical patients and 3.0 weeks for surgical patients ( P less than 0.01 ) . Within each risk group , mortality during the initial hospitalization and median long-term survival were similar among patients receiving either treatment . However , the median time to the recurrence of ascites in Group 1 was 4 months in medical patients , as compared with 18 months in surgical patients ( P = 0.01 ) ; in Group 2 it was 3 months in medical patients as compared with 12 months in surgical patients ( P = 0.04 ) . The median duration of hospitalization was longer in medical patients than in surgical patients ( 6.1 vs. 2.4 weeks in Group 1 [ P less than 0.001 ] and 5.0 vs. 3.1 weeks in Group 2 [ P less than 0.01 ] ) . Group 3 was too small to permit a meaningful comparison . During the initial hospitalization , the incidence of infections , gastrointestinal bleeding , and encephalopathy was similar among the medical and surgical patients . We conclude that peritoneovenous shunting alleviated disabling ascites more rapidly than medical management . However , survival was closely related to the severity of the illness at the time of randomization and was not altered by shunting .
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Intervention_Physical
Peritoneovenous shunting
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Intervention_Pharmacological
medical treatment
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Intervention_Pharmacological
intensive medical treatment
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Intervention_Surgical
peritoneovenous ( LeVeen ) shunting
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Outcome_Mortality
mortality
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Outcome_Mortality
median long-term survival
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Outcome_Physical
recurrence of ascites
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Outcome_Other
median duration of hospitalization
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Outcome_Adverse-effects
incidence of infections , gastrointestinal bleeding , and encephalopathy
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Outcome_Physical
disabling ascites
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Outcome_Mortality
survival
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Participant_Condition
patients with alcoholic cirrhosis and massive ascites .
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Participant_Condition
patients with alcoholic cirrhosis