Personalized Nutritional Intervention in Patients Undergoing TIPS Insertion for Refractory Ascites to Prevent Overt Hepatic Encephalopathy

Personalized Nutritional Intervention to Prevent Overt Hepatic Encephalopathy in Patients With Cirrhosis and Refractory Ascites Who Undergo TIPS Insertion: A Multicenter Randomized Controlled Trial (SUPPRESS-HE Trial)

This study will evaluate whether a nutritional intervention is better than another to reduce the incidence of overt hepatic encephalopathy in patients undergoing TIPS insertion for refractory ascites.

Inclusion Criteria:

• Diagnosis of cirrhosis
• TIPS planned for refractory ascites
• Being at least moderately malnourished

Exclusion Criteria:

• TIPS insertion for other reason than refractory ascites
• Budd Chiari Syndrome
• Complete or cavernomatous portal vein thrombosis
• Pre-TIPS recurrent or persistent overt hepatic encephalopathy
• Use of lactulose or rifaximin in the last 4 weeks
• Liver failure (MELD > 18 or Child Pugh score > 12)
• Heart failure (NYHA ≥ III or LVEF < 50%)
• Kidney failure (serum creatinine > 250µmol/L)
• Pregnancy or breastfeeding
• Previous Liver transplantation
• Unable to provide informed consent