Improvement in survival associated with embolisation of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy

An, Jihyun; Kim, K. W.; Han, Seungbong; Lee, J.; Lim, Young Suk

doi:10.1111/apt.12771

Cited by 78 publications

(77 citation statements)

References 35 publications

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“…Several authors have reported the safety and efficacy of transcatheter embolization of portosystemic shunts in patients with refractory HE [13,[32][33][34][35][36][37][38]. In addition, in the previous 10 years, many case reports on HE due to portosystemic shunts that were successfully treated by transcatheter embolization have been published [17][18][19][20][21][22][23][39][40][41][42].…”

Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

“…The details and outcomes of the reviewed studies are listed in Table 1 [13,[32][33][34][35][36][37][38].…”

Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

“…The recurrence rates of HE in clinical studies with a relatively large number of cases and comparatively longer follow-up periods range from 7.1% to 39.9% [32][33][34][35]. An et al [34] reported that the 2-year HE recurrence rate was significantly lower in patients treated with embolization than in those treated without embolization (33.9% vs. 79.9%, respectively), and the 2-year overall survival rate in patients with a MELD score < 15 without hepatocellular carcinoma was significantly higher in the embolization group than in the non-embolization group (100% vs. 60%, respectively).…”

Section: Efficacymentioning

confidence: 99%

“…In addition, portosystemic shunt embolization may improve liver function by increasing the portal flow to the liver [34]. However, the degree to which portal hypertension was exacerbated after the procedure and the amount of residual hepatic function differs considerably from patient-to-patient.…”

Section: Efficacymentioning

confidence: 99%

“…In clinical studies with a relatively high number of cases and comparatively longer follow-up periods, the incidence of esophageal varices after portosystemic shunt embolization ranges from 5% to 28.9% [32][33][34][35]. A multicenter study by Laleman et al [35] showed that 2 of 37 patients (5%) developed esophageal varices after embolization of a portosystemic shunt, of which one patient (2.5%) experienced nonfatal variceal bleeding.…”

Section: Table 1 Summary Of Published Reports Of Transcatheter Embolmentioning

confidence: 99%

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Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Takenaga

Aizawa

2017

Interventional Radiology

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Hepatic encephalopathy (HE) is a syndrome that occurs in patients with severe liver dysfunction or a portosystemic shunt. In patients with refractory HE caused by a portosystemic shunt, interventional closure of the shunt vessel is essential. Currently, transcatheter embolization is recognized as a less invasive and highly effective procedure, and it is considered as a first-choice method for the occlusion of shunt vessels. In this review, we discuss the role of a portosystemic shunt in the development of HE and describe the procedure and significance of transcatheter embolization of a portosystemic shunt.

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Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

“…The details and outcomes of the reviewed studies are listed in Table 1 [13,[32][33][34][35][36][37][38].…”

Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

Section: Table 1 Summary Of Published Reports Of Transcatheter Embolmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Takenaga

Aizawa

2017

Interventional Radiology

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Effects of restoring portal flow with anticoagulation and partial splenorenal shunt embolization

2014

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Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: A randomized controlled trial

Chen

Luo

et al. 2022

Hepatology

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Background and Aims Large spontaneous portosystemic shunt (SPSS) is associated with increased risk of HE in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to evaluate whether prophylactic embolization of large SPSS at the time of TIPS creation could reduce the incidence of post‐TIPS HE in patients with cirrhosis and variceal bleeding. Approach and Results From June 2014 to August 2017, 56 patients with cirrhosis and large SPSS planning to undergo TIPS for the prevention of variceal bleeding were randomly assigned (1:1) to receive TIPS alone (TIPS group, n = 29) or TIPS plus simultaneous SPSS embolization (TIPS+E group, n = 27). The primary endpoint was overt HE. TIPS placement and SPSS embolization was successful in all patients. During a median follow‐up of 24 months, the primary endpoint was met in 15 patients (51.7%) in the TIPS group and six patients (22.2%) in the TIPS+E group (p = 0.045). The 2‐year cumulative incidence of overt HE was significantly lower in the TIPS+E group compared with the TIPS group (21.2% vs. 48.3%; HR, 0.38; 95% CI, 0.15–0.97; p = 0.043). The 2‐year incidence of recurrent bleeding (TIPS+E vs. TIPS, 15.4% vs. 25.1%; p = 0.522), shunt dysfunction (12.3% vs. 18.6%, p = 0.593), death (15.0% vs. 6.9%, p = 0.352), and other adverse events was not significantly different between the two groups. Conclusions In patients with cirrhosis treated with TIPS for variceal bleeding, concurrent large SPSS embolization reduced the risk for overt HE without increasing other complications. Concurrent large SPSS embolization should therefore be considered for prophylaxis of post‐TIPS HE.

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Improvement in survival associated with embolisation of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy

Abstract: SUMMARY BackgroundSpontaneous portosystemic shunt (SPSS) is a frequent cause of recurrent hepatic encephalopathy (HE) in patients with cirrhosis.

Cited by 78 publications

References 35 publications

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Effects of restoring portal flow with anticoagulation and partial splenorenal shunt embolization

Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: A randomized controlled trial

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