Successful Reversal of Hepatic Encephalopathy with Intentional Occlusion of Transjugular Intrahepatic Portosystemic Shunts

Kerlan, Robert K.; LaBerge, Jeanne M.; Baker, Edward L.; Wack, Jon P.; Marx, M; Somberg, Kenneth A.; Gordon, Roy L.; Ring, Ernest J.

doi:10.1016/s1051-0443(95)71212-x

Cited by 85 publications

(39 citation statements)

References 15 publications

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“…15 In most patients, the encephalopathy responds to standard therapy, and only rarely (Ϸ5%) must the TIPS be occluded to control the encephalopathy. 62,63 A TIPS also can be reduced in caliber should excessive encephalopathy prove difficult to control and yet allow for continued portal decompression. 64 There is no data supporting the use of lactulose in all patients following a TIPS to reduce the incidence of encephalopathy.…”

Section: Complicationsmentioning

confidence: 99%

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

2005

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Section: Complicationsmentioning

confidence: 99%

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

2005

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“…Consequently, these treatments result in decreased portal hepatic blood flow, which may cause liver failure and can aggravate hepatic encephalopathy (18-20). …”

mentioning

confidence: 99%

Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleeding: Its Feasibility Compared with Transjugular Intrahepatic Portosystemic Shunt

et al. 2003

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ObjectiveTo assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS).Materials and MethodsTwenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test.ResultsOne patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02).ConclusionBRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.

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“…[26][27][28] In addition, the induction of hepatic encephalopathy is also a well-known complication of TIPS. [29][30][31] Olson et al 32 reported the treatment of gastric varices with the retrograde obliteration of the gastric varices with absolute ethanol and coils via the gastrorenal shunt through the femoral vein. The first reported treatment of gastric varices by B-RTO with 5% EOI was described by Kanagawa et al 6 Since their report, the procedure has been used because of its relatively low invasiveness and high therapeutic effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Emergency balloon-occluded retrograde transvenous obliteration for gastric varices

et al. 2005

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show abstract

Successful Reversal of Hepatic Encephalopathy with Intentional Occlusion of Transjugular Intrahepatic Portosystemic Shunts

Cited by 85 publications

References 15 publications

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleeding: Its Feasibility Compared with Transjugular Intrahepatic Portosystemic Shunt

Emergency balloon-occluded retrograde transvenous obliteration for gastric varices

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