Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Schistosomiasis-Induced Liver Fibrosis

Liu, Jiacheng; Zhou, Binqian; Chen, Dongpin; Zhou, Chen; Shi, Qing; Zheng, Chuansheng; Gao, Feng; Yuan, Feng; Ge, Yan; Xiong, Bin

doi:10.1007/s00270-019-02295-6

Cited by 15 publications

(15 citation statements)

References 41 publications

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“…The rates of hepatic encephalopathy in HSS patients after TIPS implantation in the Egyptian study and the Chinese study were reported with 19% and 25% respectively, comparable to post-interventional results of patients with hepatitis B-associated liver cirrhosis [22]. In our case series, we observed encephalopathy episodes which required hospitalization in five patients (39%), two of whom had preexisting liver dysfunction due to hepatitis B-coinfection.…”

Section: Discussionsupporting

confidence: 77%

“…Since 1994, only few case reports and one small case series of TIPS as treatment for advanced disease have been published [19][20][21]. Recently, a retrospective study on TIPS in 20 patients with HSS (S. japonicum) and 62 patients with HBV-induced liver cirrhosis showed comparable results for both groups in terms of hepatic encephalopathy, re-bleeding and survival [22].…”

Section: Introductionmentioning

confidence: 99%

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TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

et al. 2021

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Background Transjugular intrahepatic portosystemic shunt (TIPS) and shunt surgery are established treatment options for portal hypertension, but have not been systematically evaluated in patients with portal hypertension due to hepatosplenic schistosomiasis (HSS), one of the neglected tropical diseases with major impact on morbidity and mortality in endemic areas. Methods In this retrospective case study, patients with chronic portal hypertension due to schistosomiasis treated with those therapeutic approaches in four tertiary referral hospitals in Germany and Italy between 2012 and 2020 were included. We have summarized pre-interventional clinical data, indication, technical aspects of the interventions and clinical outcome. Findings Overall, 13 patients with confirmed HSS were included. 11 patients received TIPS for primary or secondary prophylaxis of variceal bleeding due to advanced portal hypertension and failure of conservative management. In two patients with contraindications for TIPS or technically unsuccessful TIPS procedure, proximal splenorenal shunt surgery in combination with splenectomy was conducted. During follow-up (mean follow-up 23 months, cumulative follow-up time 31 patient years) no bleeding events were documented. In five patients, moderate and transient episodes of overt hepatic encephalopathy were observed. In one patient each, liver failure, portal vein thrombosis and catheter associated sepsis occurred after TIPS insertion. All complications were well manageable and had favorable outcomes. Conclusions TIPS implantation and shunt surgery are safe and effective treatment options for patients with advanced HSS and sequelae of portal hypertension in experienced centers, but require careful patient selection.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

et al. 2021

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“…Patients with advanced schistosomiasis-induced liver fibrosis gradually develop cirrhosis due to egg deposition, and often die of gastrointestinal bleeding and liver failure caused by portal hypertension (Barnett, 2018;Chuah et al, 2019;Lewis and Tucker, 2019). Numerous studies have documented that liver fibrosis can be reversed, but liver cirrhosis is totally irreversible (Kamdem et al, 2018;Cai et al, 2019;Liu et al, 2019). Therefore, it is of importance to develop strategies for preventing or treating liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

In vivo Therapeutic Effects and Mechanisms of Hydroxyasiaticoside Combined With Praziquantel in the Treatment of Schistosomiasis Induced Hepatic Fibrosis

Fang

You

et al. 2021

Front. Bioeng. Biotechnol.

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Schistosomiasis has been a fatal obstinate disease that threatens global human health, resulting in the granulomatous inflammation and liver fibrosis.Objective:The aim of this study was to evaluate the therapeutic effects and mechanisms of hydroxyasiaticoside combined with praziquantel in the treatment of schistosomiasis-induced liver fibrosis.Methods:Mice were randomly distributed into four experimental groups: normal control group, model group, praziquantel group, praziquantel + hydroxyasiaticoside group. Except for the normal control group, they were infected with Schistosomia cercariae through the abdominal skin to induce liver fibrosis. In the intervention group, mice were administered with the respective drugs by gavage after 8 weeks of infection. At the end of the treatment, mice were sacrificed to collect blood for the determination of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels. Moreover, the liver was excised, weighed, and liver indices were calculated. Histopathological examination was performed to assess liver morphology. Besides, the expression of collagen type I and III in liver was determined; the mRNA expression levels of IL-6 and TNF-α in liver tissues were measured using Real-time PCR while ELISA and western blotting were performed on liver tissue homogenate to determine the protein expression of IL-6 and TNF-α.Results:The combination of praziquantel and hydroxyasiaticoside lowered the pathological scores of schistosomiasis-induced hepatic fibrosis, the liver indice, serum AST and ALT levels, improved liver morphology, downregulated the expression levels of hepatic type I and III collagen, inhibited the mRNA expression levels of pro-inflammatory factors (IL-6 and TNF-α) in the liver of mice relative to the praziquantel alone.Conclusion:The combination of hydroxyasiaticoside and praziquantel is a potential therapeutic option for schistosomiasis-induced hepatic fibrosis. Notably, this combination noticeably suppresses the protein and mRNA expression levels of pro-inflammatory factors (TNF-α and IL-6) in the liver.

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“…Regarding the hepatic encephalopathy rate, this would appear lower than or comparable to that following DSRS; however, it is difficult to drive conclusions due to the small number of published cases managed with TIPS and the heterogeneity in the length of follow-up. The largest cohort of patients with HSS treated with TIPS was described from China [ 99 ] and reported the highest rate of development of portal encephalopathy, which in other published cases seems having occurred only in patients coinfected with viral hepatitis or precipitating factors [ 75 , 100 ]. It remains therefore to clarify if the peculiar clinical characteristics (e.g., refractory ascites) and apparently high rate of portal encephalopathy observed in the Chinese cohort were due to the presence of coinfections that were not diagnosed, or to a specific disease course due to infection with S .…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

et al. 2021

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Background Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS. Methodology/principal findings We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking. Conclusions Most interventions have been developed on the basis of individual groups’ experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.

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Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Schistosomiasis-Induced Liver Fibrosis

Cited by 15 publications

References 41 publications

TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis–A case series and review of the literature

In vivo Therapeutic Effects and Mechanisms of Hydroxyasiaticoside Combined With Praziquantel in the Treatment of Schistosomiasis Induced Hepatic Fibrosis

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

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