Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Recurrent Variceal Hemorrhage

Abstract

Purpose. The purpose of this study was to determine the incidence and predictors of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) in the elective treatment of recurrent variceal hemorrhage. Methods. Seventy patients were treated with elective TIPS and fifty-six patients with ET. Median observation time was 46.28 months in the TIPS group and 42.31 months in the ET group. Results. 30 patients (42.8%) developed clinically evident portosystemic encephalopathy in TIPS group and 20 patients (35.6%) in ET group. The difference between the groups was not statistically significant (P = 0.542; χ 2 test). The incidence of new or worsening portosystemic encephalopathy was 24.3% in TIPS group and 10.7% in ET group. Multivariate analysis showed that ET treatment (P = 0.031), age of >65 years (P = 0.022), pre-existing HE (P = 0.045), and Child's class C (P = 0.051) values were independent predictors for the occurrence of HE. Conclusions. Procedure-related HE is a complication in a minority of patients treated with TIPS or ET. Patients with increased age, preexisting HE, and higher Child-Pugh score should be carefully observed after TIPS procedure because the risk of post-TIPS HE in these patients is higher.

Race and Gradient Difference Are Associated with Increased Risk of Hepatic Encephalopathy Hospital Admission After Transjugular Intrahepatic Portosystemic Shunt Placement

“…Reported incidence of post-TIPS HE has varied significantly across studies, ranging from 22% to 50% in individual series. 2,[12][13][14][15][16][17][18][19][20] In a meta-analysis of 14 randomized controlled trials which compared TIPS to standard therapy in variceal bleeding, the overall rate was found to be 33% in the TIPS group vs. 19% in the control group. 21 The definition of post-TIPS HE has also varied between studies.…”

“…11 Estimates range from 22% to 50% depending on the exact definition of HE used and patient demographics. 2,[12][13][14][15][16][17][18][19][20] Likewise, risk factors for development of post-TIPS HE have varied between studies. One large meta-analysis found age over 65, advanced Child-Pugh score and history of HE to be robust predictors.…”

Pathological Predictors of Shunt Stenosis and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt

“…Merola et al showed that higher MELD scores, hyponatremia, and higher total bilirubin level were associated with the development of overt HE post-TIPS [18]. Other studies demonstrated that the risk of post-TIPS HE was higher in the patients with increased age, preexisting HE, and higher Child-Pugh score [19, 20]. Although there have been some hypotheses of HE, the underlying molecular mechanisms remain unclear.…”

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

“…Also increased number of toxins are presented to liver hepatocytes for detoxification. This can be achieved by shunt reduction or occlusion techniques (6,7,19,21,30,36). An understanding of the anatomy and physiology of the portal system as well as porto-systemic haemodynamic and flow directional changes that occur in the presence of cirrhosis is essential prior to the discussion of techniques for shunt reduction.…”

“…Hepatic encephalopathy is classified into three major categories, according to the underlying aetiology. Type A occurs in patients with acute liver failure, type B occurs in patients with portosystemic shunting without intrinsic liver disease and type C is related to cirrhosis .…”