Prevalence, clinical characteristics, and outcomes of spontaneous portosystemic shunt in patients with hepatitis B-related cirrhosis: A multicenter study from China

Ke, Qiao; Yu, Xueping; Wang, Xuan; Huang, Jinfa; Lin, Biding; He, Jian; Wang, Zhiyong; Huang, Xin; Weng, Xiadi; Jiao, Yubin; Xie, Yixing; Wei, Weimin; Qiu, Linbin; Li, Ling; Xu, Zhengju; Su, Zhijun; Zhuge, Yuzheng; Liu, Jingfeng; Guo, Wenping

doi:10.1016/j.dld.2023.04.012

Cited by 2 publications

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“…A solitary SPSS refers to the presence of a lone shunt, whereas multiple SPSS indicates the existence of ≥ 2 shunts. In the current study, the subtypes of SPSS included splenorenal, paraumbilical vein, gastrorenal, mesocaval, and intrahepatic portosystemic shunts 11 .…”

Section: Methodsmentioning

confidence: 99%

“…SPSS are abnormal communication channels connecting the portal venous system with the systemic circulation that form in response to portal hypertension 6 . Early investigations suggested that these shunts may reduce portal pressure to a certain extent 7 , 8 ; however, recent research suggests that SPSS can decrease hepatic perfusion, exacerbate liver function deterioration, increase the incidence of HE, and hasten the progression of chronic liver failure 9 – 11 . Previous studies have demonstrated an association between HE recurrence and the presence of SPSS, revealing the presence of SPSS in 46–71% of patients with refractory HE 8 , 12 .…”

Section: Introductionmentioning

confidence: 99%

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Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

Ke,

He,

Cai

et al. 2024

Sci Rep

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This study aimed to assess the safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy (HE) associated with large spontaneous portosystemic shunts (SPSS). Inverse probability of treatment weighting (IPTW) was employed to minimize potential bias. A total of 123 patients were included in this study (34 in the embolization group and 89 in the control group). In the unadjusted cohort, the embolization group demonstrated significantly better liver function, a larger total area of SPSS, and a higher percentage of patients with serum ammonia levels > 60 µmol/L and the presence of hepatocellular carcinoma (HCC) (all P < 0.05). In the IPTW cohort, baseline characteristics were comparable between the two groups (all P > 0.05). Patients in the embolization group exhibited significantly longer HE-free survival compared to the control group in both the unadjusted and IPTW cohorts (both P < 0.05). Subsequent subgroup analyses indicated that patients with serum ammonia level > 60 μmol/L, hepatopetal flow within the portal trunk, the presence of solitary SPSS, a baseline HE grade of II, and the absence of HCC at baseline showed statistically significant benefit from embolization treatment (all P < 0.05). No early procedural complications were observed in the embolization group. The incidence of long-term postoperative complications was comparable to that in the control group (all P > 0.05). Hence, interventional embolization appears to be a safe and effective treatment modality for cirrhotic patients with refractory HE associated with large SPSS. However, the benefits of embolization were discernible only in a specific subset of patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

Ke,

He,

Cai

et al. 2024

Sci Rep

Self Cite

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Interventional embolisation for patients with cirrhosis and recurrent or persistent hepatic encephalopathy related to spontaneous portosystemic shunts: protocol for a prospective, non-randomised controlled study

Ke,

Lin,

Lei

et al. 2024

BMJ Open

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IntroductionThe presence of spontaneous portosystemic shunts (SPSS) has been identified to be associated with hepatic encephalopathy (HE) in patients with cirrhosis. Nevertheless, the role of interventional embolisation in managing such patients remains poorly defined. Consequently, this prospective controlled study aims to assess the efficacy and safety of interventional embolisation as a therapeutic approach for patients with cirrhosis and recurrent or persistent HE related to SPSS.Methods and analysisCirrhotic patients diagnosed with recurrent or persistent HE associated with SPSS will be recruited for this study, and assigned to either the interventional embolisation group or the standard medical treatment group. The efficacy endpoints encompass the evaluation of postoperative alleviation of HE symptoms and the incidence of overt HE recurrence during the follow-up period, as well as the duration and frequency of hospitalisations for HE, alterations in liver function and volume, and overall survival. The safety endpoints encompass both immediate and long-term postoperative complications.Ethics and disseminationThis study will be conducted in strict adherence to the principles of good clinical practice and the guidelines outlined in the Declaration of Helsinki. Ethical approval for the trial has been obtained from the Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University (2023_013_02). Written informed consent will be obtained from all the participants by the treating physician for each patient prior to their enrolment. The documented informed consent forms will be retained as part of the clinical trial records for future reference. The study findings will be disseminated through publication in peer-reviewed journals and will be presented at international conferences.Trial registration numberChiCTR2300072189.

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Prevalence, clinical characteristics, and outcomes of spontaneous portosystemic shunt in patients with hepatitis B-related cirrhosis: A multicenter study from China

Cited by 2 publications

References 32 publications

Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

Interventional embolisation for patients with cirrhosis and recurrent or persistent hepatic encephalopathy related to spontaneous portosystemic shunts: protocol for a prospective, non-randomised controlled study

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