Technical Feasibility and Clinical Effectiveness of Transjugular Intrahepatic Portosystemic Shunt Creation in Pediatric and Adolescent Patients

Bertino, Frederic J.; Hawkins, C. Matthew; Shivaram, Giridhar M.; Gill, Anne E.; Lungren, Matthew P.; Reposar, A.; Sze, Daniel Y.; Hwang, Gloria L.; Koo, Kevin S. H.; Monroe, Eric J.

doi:10.1016/j.jvir.2018.10.003

Cited by 34 publications

(50 citation statements)

References 31 publications

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“…(263)(264)(265)(266) In small numbers of children with RA, TIPS has been shown to be a highly effective treatment approach for ascites. (263,264) Reported rates of hepatic encephalopathy after TIPS in children vary between 0% and 48%.…”

Section: Diagnosis and Management Of Ascites In Childrenmentioning

confidence: 99%

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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This is a comprehensive guidance on the diagnosis, evaluation, and management of ascites and hepatorenal syndrome in patients with chronic liver disease from the American Association for the Study of Liver Diseases (AASLD). It replaces the prior AASLD guideline on the same topic published in 2012 (1).This AASLD Guidance provides a data-supported approach to the management of ascites and hepatorenal syndrome. It differs from AASLD Guidelines, which are supported by systematic reviews of the literature, formal rating of the quality of the evidence and strength of the recommendations. In contrast, this Guidance was developed by consensus of an expert panel and provides guidance statements based on comprehensive review and analysis of the literature on the topics, with oversight provided by the AASLD Practice Guidelines Committee. The AASLD Practice Guidelines Committee chose to perform a Guidance on this topic because a sufficient number of randomized controlled trials were not available to support meaningful systematic reviews and meta-analyses. A. Introduction Burden of Cirrhotic Ascites and Hepatorenal SyndromeHepatic decompensation, defined by ascites, hepatic encephalopathy, and portal hypertensive gastrointestinal bleeding, is an important landmark in the natural history of cirrhosis (2). Ascites is commonly the first decompensation-defining event, with 5%-10% of patients with compensated cirrhosis developing ascites per year (3). The development of ascites is associated with a reduction in 5-year survival from 80% to 30% (4), which is due in part to patients with ascites being prone to additional complications such as bacterial infections, electrolyte abnormalities, hepatorenal syndrome (HRS) and nutritional imbalances, and consequently, further clinical decline (5). Patients with cirrhosis who develop clinically significant ascites and related complications should be considered for referral for liver transplantation (LT) evaluation and, where appropriate, palliative care (6).HRS is a late complication of cirrhosis that accounted for 3.2% of all hospital discharges related to cirrhosis according to a 2012 study based on a large inpatient health care database of patients representative of community hospitals in the United States (4). Moreover, the number of HRS discharges in the United States has increased significantly in the past 2 decades (7). HRS was also associated with high inpatient mortality (~46%), as well as longer lengths of stay and higher costs of hospitalizations, compared to cirrhosis discharges without HRS.

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Section: Diagnosis and Management Of Ascites In Childrenmentioning

confidence: 99%

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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“…In paediatric patients with portal hypertension refractory to medical management decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be haemodynamically advantageous with fairly good clinical outcomes 9 . The smallest patient described in this series was 1.5 years old with a body weight of 11.4 kg 9 .…”

Section: Discussionmentioning

confidence: 95%

Stenting of ductus venosus as a palliation for portal hypertension because of neonatal cirrhosis

Brown

Bhatt

Salunke

et al. 2022

Liver International

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Portal hypertension because of liver cirrhosis is a significant cause of morbidity and mortality. Treatment options in these patients include liver transplant, symptomatic treatment of oesophageal varices via endoscopic treatment and symptomatic management of ascites. Portosystemic shunt creation can be challenging in newborns and infants. We present a newborn with Trisomy 21, severe portal hypertension secondary to neonatal cirrhosis, oesophageal varices and upper GI bleeding, severe ascites refractory to medical management who underwent ductus venosus stenting as a palliative procedure. He demonstrated remarkable clinical improvement with no subsequent upper GI bleed and resolution of ascites till his last follow‐up at 12 months of age. To the best of our knowledge, stenting of the patent ductus venosus to create a portosystemic shunt to relieve portal hypertension has not been reported in English literature.

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“…According to several studies, incidence of hepatic encephalopathy after TIPS for pediatric patients seemed to be lower than adults, ranging from 0 to 15% during the follow-up period up to 104 months (2, 11–13). Lower rate of hepatic encephalopathy might be attributed to prehepatic portal hypertensive etiologies without liver cirrhosis (as in this case) in pediatric patients (2, 11). However, another study suggested that nearly half of their pediatric patients undergoing TIPS would develop hepatic encephalopathy (14).…”

Section: Discussionmentioning

confidence: 99%

“…Intriguingly, the authors in this study suggested that this high rate of hepatic encephalopathy might be related with medical comorbidities and over-dilation of shunts in their cohort (14). Nevertheless, all these reported hepatic encephalopathy had been successfully managed with medication (2, 11–14). It seemed that hepatic encephalopathy might be a minor problem after TIPS in pediatric patients compared with that in adults.…”

Section: Discussionmentioning

confidence: 99%

Cavernous Transformation of the Portal Vein in a 26-Month Old Boy Treated by Transjugular Intrahepatic Portosystemic Shunt: A Case Report

et al. 2019

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Cavernous transformation of portal vein (CTPV) is the main cause of portal hypertension and its related variceal bleeding in children. Transjugular intrahepatic portosystemic shunt (TIPS) was not reported to treat CTPV for children younger than 5 years old. In this case report, the patient was a 26-month-old boy who presented with hematemesis and melena due to CTPV. Even after azygoportal disconnection, repeated hematemesis as well-melena still occurred. After careful evaluation, we performed TIPS under general anesthesia for him. The procedure was uneventful, and 6-mm stents were inserted. Six months after TIPS, there was no recurrence of bleeding, and no procedure-related event happened. The follow-up esophagogastroduodenoscopy proved dramatic remission of varices, indicating a successful outcome. We believe TIPS could be safely placed for young children to manage variceal bleeding due to CTPV.

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Technical Feasibility and Clinical Effectiveness of Transjugular Intrahepatic Portosystemic Shunt Creation in Pediatric and Adolescent Patients

Cited by 34 publications

References 31 publications

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

Stenting of ductus venosus as a palliation for portal hypertension because of neonatal cirrhosis

Cavernous Transformation of the Portal Vein in a 26-Month Old Boy Treated by Transjugular Intrahepatic Portosystemic Shunt: A Case Report

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