Comparison of transjugular intrahepatic portosystemic shunt for treatment of variceal bleeding in patients with cirrhosis with or without spontaneous portosystemic shunt

Leng, Xin; Zhang, Feng; Zhang, Ming; Guo, Hu; Yin, Xiaochun; Xiao, Jiangqiang; Wang, Yi; Zou, Xiaoping; Zhuge, Yuzheng

doi:10.1097/meg.0000000000001349

Cited by 20 publications

(28 citation statements)

References 29 publications

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“…They also showed that these patients did not have a higher risk of rebleeding, recurrence of ascites, TIPS dysfunction or death of any cause. Similar results were obtained byLeng et al in a recent study that evaluated the efficacy of TIPS combined with SPSS embolization in variceal bleeding, comparing the results and risks with patients without SPSSs 107. In this study, a control group submitted to TIPS with nonembolized SPSSs was not included.…”

supporting

confidence: 71%

“…Some studies suggest that pre-existing large SPSSs increase the risk of post-TIPS HE, which diminishes when these shunts are embolized. 106 – 109 After TIPS placement, nearly one-third of SPSSs remained unchanged, although with a reduction in portal pressure. He et al proposed prophylactic embolization of SPSS during TIPS, and showed that the risk of HE was similar to those without shunts [hazard ratio (HR) for HE in 5 years of 1 (TIPS) versus 1.38 (1.08–1.77) (TIPS + SPSS) versus 0.82 (0.49–1.37) (TIPS + embolization); p = 0.029].…”

Section: Spss and Outcomes After Tipsmentioning

confidence: 99%

“…Similar results were obtained by Leng et al in a recent study that evaluated the efficacy of TIPS combined with SPSS embolization in variceal bleeding, comparing the results and risks with patients without SPSSs. 107 In this study, a control group submitted to TIPS with nonembolized SPSSs was not included. By contrast, in terms of survival, Borentain et al found that concomitant SPSSs were associated not only with the appearance of HE, but also with an increased risk of early mortality after TIPS.…”

Section: Spss and Outcomes After Tipsmentioning

confidence: 99%

“…Some studies suggest that pre-existing large SPSSs increase the risk of post-TIPS HE, which diminishes when these shunts are embolized. [106][107][108][109] 108 However, the follow-up was limited to the first 30 days after TIPS placement. More evidence is needed to obtained solid conclusions.…”

Section: Spss and Outcomes After Tipsmentioning

confidence: 99%

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Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

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Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.

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supporting

confidence: 71%

Section: Spss and Outcomes After Tipsmentioning

confidence: 99%

Section: Spss and Outcomes After Tipsmentioning

confidence: 99%

Section: Spss and Outcomes After Tipsmentioning

confidence: 99%

See 2 more Smart Citations

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

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“…The HVPG measurement procedures were described as previous studies [ 14 , 15 ]: in brief, a 7-F balloon-tipped catheter (Edwards Lifesciences, Irvine, California, USA) was guided into the right or middle hepatic vein to measure the WHVP and FHVP, for three times, and the HVPG was calculated. After the initial HVPG measurement, the patients received oral propranolol or carvedilol.…”

Section: Methodsmentioning

confidence: 99%

Increase in Free Hepatic Venous Pressure Response to Beta-Blockers Predicts Variceal Bleeding in Cirrhotic Patients

Guo

Xiao

Wang

et al. 2021

BioMed Research International

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Background and Aims. Nonselective beta-blockers (NSBBs) are the main drug to prevent portal hypertension. It could alter free hepatic venous pressure (FHVP); however, the significance is unknown. This prospective study was to explore the change of FHVP after use of NSBBs and its predictive value for gastroesophageal varices (GOV) bleeding in cirrhotic patients. Patients and Methods. Cirrhotic patients with medium-large GOV between September 2014 and January 2019 were enrolled. After initial hepatic venous pressure gradient (HVPG) measurement, patients received oral NSBBs. Seven days later, the secondary HVPG was examined to evaluate the FHVP alteration and hemodynamic response. The variceal bleeding between patients with FHVP increased and decreased/unchanged was compared. Results. A total of 74 patients were enrolled, and 62 patients completed the secondary HVPG measurement and was followed up. The cumulative bleeding rate was significantly higher in patients with FHVP increased ≥ 1.75 mmHg than those with FHVP decreased/unchanged (54.5% vs. 22.5%, p = 0.021 ), while there was no significant difference in bleeding between HVPG responders and nonresponders (32.6% vs. 37.5%, p = 0.520 ). For HVPG responders, variceal bleeding in patients with FHVP increased ≥ 1.75 mmHg was significantly more than that in patients with FHVP decreased/unchanged (57.9% vs. 28.6%, p = 0.041 ). Cox regression analysis showed that change of FHVP was an independent predictor of variceal bleeding. Conclusion. Increase ≥ 1.75 mmHg in FHVP responding to beta-blockers in cirrhotic patients with GOV indicates high risk of variceal bleeding. Besides HVPG response, change of FHVP should also be valued in hemodynamic evaluation to beta-blockers. This trial is registered with Chinese Clinical Trial Registry ChiCTR-IPR-17012836.

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Prophylactic embolization of large spontaneous portosystemic shunts with transjugular intrahepatic portosystemic shunt (TIPS): A panacea for post‐TIPS hepatic encephalopathy?

Tripathi

Bureau

2022

Hepatology

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Transjugular intrahepatic portosystemic shunt (TIPS) has revolutionized the management of portal hypertension, with recent guidelines supporting its use, particularly in recurrent ascites and as a preemptive therapy in acute variceal bleeding, due to significant survival benefits. [1] However, a nagging thorn has been the risk of post-TIPS HE, which can affect more than half of patients. [2] Risk factors include previous episodes of overt HE, age > 65, minimal HE, sarcopenia, and severity of liver disease (Figure 1). [1,3] Guidelines currently recommend screening carefully for overt and minimal HE prior to elective TIPS. [1,4] An important risk factor not always considered is the presence of spontaneous portosystemic shunt (SPSS). The belief that SPSS helps to decompress the portal venous system has not been confirmed, with studies showing that SPSS correlates with liver dysfunction and decompensating events such as HE, varices, and hepatorenal syndrome. [5] Hence, SPSS is an insufficient compensatory mechanism, not allowing for a sufficient reduction of portal pressure, and could result in a decrease of liver perfusion. It is believed that SPSS forms thorough VEGF-driven angiogenesis and neovascularization, [6] with the most common being splenorenal shunts, gastrorenal shunts, gastrocaval shunts, and recanalized paraumbilical vein. Gastrorenal shunts are evident in up to 85% of patients with cardiofundal gastric varices. SPSSs are best seen on crosssectional imaging, and a recent Baveno VI collaborative study showed SPSS in 60% of patients, with large ones (>8 mm) seen in half of the patients. [5] The same group found that even in compensated cirrhosis, SPSSs were seen in up to 55% of patients and that a total surface area >83 mm 2 predicted overt HE and mortality.Therefore, selective embolization of large SPSSs would seem an attractive option. Indeed, studies confirm this, with nearly two thirds of patients remaining free of HE over a 2-year follow-up after embolization. [7] While the prevalence of SPSS can reach 60%

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Comparison of transjugular intrahepatic portosystemic shunt for treatment of variceal bleeding in patients with cirrhosis with or without spontaneous portosystemic shunt

Cited by 20 publications

References 29 publications

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Increase in Free Hepatic Venous Pressure Response to Beta-Blockers Predicts Variceal Bleeding in Cirrhotic Patients

Prophylactic embolization of large spontaneous portosystemic shunts with transjugular intrahepatic portosystemic shunt (TIPS): A panacea for post‐TIPS hepatic encephalopathy?

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