Mitigation of Sarcopenia after Denver Shunt Placement in Patients with Refractory Ascites.
Academic Article
Overview
abstract
PURPOSE: To evaluate the effect of peritoneonvenous shunt (Denver Shunt) placement on metrics of sarcopenia in patients with refractory ascites. MATERIALS AND METHODS: IRB-approved single-institution retrospective analysis of all patients undergoing Denver Shunt (n = 29) and a comparator cohort of cirrhotics undergoing serial paracentesis (n = 42) from 2009-2019 with baseline and follow-up cross sectional imaging of at least 3 months. Axial muscle area measurements (psoas, paraspinal, total abdominal wall) were performed using free-hand region of interest technique. Patient records were reviewed for demographics, referring indication, laboratory studies, and performance status. Statistical analyses were performed with Student's t test, Welch's unequal variances, Fisher's exact, and Wilcoxon signed ranks. RESULTS: The most common indications for Denver Shunt placement were metastatic disease or cirrhosis. For all shunt patients, there were no significant differences in aggregate psoas muscle area (13.4 vs. 14 cm2, p = 0.223) or paraspinal muscle area (43 vs. 42.2 cm2, p = 0.471). In the paracentesis cohort there were significant decreases in aggregate psoas (18.1 vs. 15.7 cm2, p < 0.0001) and erector spinae (43.4 vs. 39.9 cm2, p < 0.0001) muscle area. There was also a significant decrease in serum albumin (3.2 vs. 3 g/dL, p = 0.015) and ECOG performance status (1 vs. 1.3, p < 0.0001) in the serial paracentesis group, compared to no significant change in the shunt cohort. CONCLUSION: In patients with refractory ascites who are not candidates for TIPS placement, Denver Shunt mitigates loss of truncal muscle and in some instances promotes muscle growth.
