Current diagnosis and management of post‐transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy

Pereira, Keith; Carrion, Andres F.; Martin, Paul L.; Vaheesan, K.; Salsamendi, Jason; Doshi, Mehul; Yrizarry, Jose M.

doi:10.1111/liv.12956

Cited by 47 publications

(38 citation statements)

References 59 publications

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“…3 -7 % der Patienten nach TIPS-Implantation sprechen auf eine medikamentöse Therapie der HE jedoch nicht an und sind entsprechend therapierefraktär [707,708]. Interventionelle Verfahren wie die TIPS-Okklusion oder Stentreduktion können in solchen Einzelfällen bei einer akuten HE-Episode hilfreich sein [709,710]. Von 189 Patienten bekamen 12 nach TIPS-Implantation eine HE, die auf eine medikamentöse Therapie nicht ansprach [706].…”

Section: Kommentarunclassified

“…Vor Einsatz interventioneller Verfahren sollte eine klare kausale Verbindung zwischen TIPS-Implantation und Auftreten der HE hergestellt werden: Die HE sollte zeitlich nah an dem Eingriff aufgetreten sein, der erzielte portosystemische Gradient ist niedrig und/oder die Leberfunktion verschlechtert sich nach dem Eingriff [710]. Der Vorteil einer Besserung der HE muss gegen das Risiko einer erneuten Varizenblutung oder Aszitesbildung abgewogen werden.…”

Section: Kommentarunclassified

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Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

et al. 2019

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ZusammenfassungDie Leitlinie Komplikationen der Leberzirrhose der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) ersetzt die Leitlinie aus dem Jahr 2011. Sie basiert auf den Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) für eine evidenzbasierte Konsensus-Leitlinie der Entwicklungsstufe S2k und wurde interdisziplinär unter Beteiligung aller relevanten Fachgesellschaften und der Patientenvertretung erstellt. Neben den in der Vorgängerversion behandelten Kapiteln Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom, hepatischer Hydrothorax und hepatopulmonales Syndrom wurden die Kapitel Diagnostik und Therapie der Hepatischen Enzephalopathie neu aufgenommen.

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Section: Kommentarunclassified

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

et al. 2019

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“…A TIPS is useful in the management of the complications of portal hypertension, in particular, gastroesophageal varices, although its insertion precipitates HE [27,28]. A recent study by Routhu et al suggested that several factors (in particular, age, pre-TIPS portal venous pressure, serum creatinine, presence of diabetes mellitus, and etiology of portal hypertension) are significantly associated with the development of overt HE after TIPS [29].…”

Section: Evaluation Associated With the Pathogenesis Of He In Lcmentioning

confidence: 99%

Therapeutic Strategies and Current Management for Hepatic Encephalopathy in Liver Cirrhosis

Suzuki¹,

Kato²,

Takikawa³

2019

obm hg

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Hepatic encephalopathy (HE) is a neuropsychiatric syndrome with a wide spectrum of symptoms and one of the serious complications seen in patients with acute and chronic liver disease or spontaneous portal-systemic shunting. HE is usually classified into three types according to the underlying cause (A, B, and C). Some recent discussions suggest a fourth type (D) to exclusively include HE patients with acute-on-chronic liver failure. HE has also been classified into coma grades I to IV according to the West Haven criteria, while the International Society for Hepatic Encephalopathy and Nitrogen Metabolism has proposed two distinct categories: covert HE (includes minimal HE, which is identified solely through psychometric or neurological tests and coma grade I) and overt HE (coma grade II-IV). Although modern therapeutic approaches based on clinical evidence have gradually improved the outcomes of cirrhotic patients with HE, recurrent or resistant HE is still common and the prognosis in patients with severe liver dysfunction is still poor. In this article, we discuss the therapeutic strategies and current management, except for liver transplantation and interventional procedures for portal-systemic shunting, in cirrhotic patients with HE.

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“…41 These methods based on partial or complete occlusion of the shunt have been adopted to control the portosystemic shunt overflow that can occur after a TIPS placement. 42 Although initial attempts at percutaneous shunt occlusion with coils or detachable balloons were successful, 43 these techniques were associated with a high morbidity and mortality 44 related to the recurrence of variceal bleeding or to balloon migration into the right side of the hearth or balloon rupture. Now a days the Amplatzer Vascular Plug (AVP; AGA Medical, Golden Valley, MN, USA) is favored in occluding large-diameter high-flow vessels because of the lack of migration and ease of placement.…”

Section: Techniques Of Tips Reduction-clinical Implications and Litermentioning

confidence: 99%

Radiological Intervention for Shunt Related Encephalopathy

Nardelli

Gioia

Riggio

2018

Journal of Clinical and Experimental Hepatology

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Hepatic Encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Several clinical and pathophysiologic observations suggest the importance of portal-systemic shunts in the development of HE. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment. This latter type of HE should be related to spontaneous or radiological (such as Transjugular Intrahepatic Portosystemic Shunt (TIPS)) portal systemic shunts, that could be restricted or occluded in patients with chronic HE. Both TIPS reduction and shunt occlusion are radiological procedures, safe and effective to ameliorate neurological symptoms in patients with refractory HE. ( J CLIN EXP HEPATOL 2018;8:452-459) PORTOSYSTEMIC SHUNTS IN CIRRHOSIS-CLASSIFICATION, TYPES, CLINICAL IMPLICATIONS, NATURAL HISTORY SPSSs are, as the name implies, potential communications between the portal venous system and the systemic venous circulation than can open and grow when portal pressure increases. These SPSS act as "release valves" to reduce the portal pressure, but also act as bypasses to normal liver flow. At one point, the shunt becomes large enough that it starts contributing to the progression of the liver disease. 8 The main types of SPSSs are: paraumbilical vein, splenorenal, splenoiliac with internal hemorrhoids, esophageal varices and gastrocaval, indirect gastrocaval, gastrorenal associated with gastric varices. 8 SPSSs can be classified into left-sided and right-sided (central) shunts; the most frequent right-side shunt is represented by recanalization of paraumbilical vein, while the most common left-sided shunts are gastrorenal shunt, observed in 85% of patients with gastric varices, gastrocaval shunt and splenorenal shunt. The clinical manifestations of these latter shunts comprise gastric variceal bleeding, HE and portal vein

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Current diagnosis and management of post‐transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy

Cited by 47 publications

References 59 publications

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

Therapeutic Strategies and Current Management for Hepatic Encephalopathy in Liver Cirrhosis

Radiological Intervention for Shunt Related Encephalopathy

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