Clinical

Portosystemic shunt modification helpful in hepatic encephalopathy

Last Updated: 2006-10-31 15:55:19 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In many patients who experience hepatic encephalopathy following transjugular intrahepatic portosystemic stent shunt (TIPSS) insertion for management of portal hypertension, percutaneous modification of the existing shunt may be helpful, Scottish researchers report in the November issue of Gut.

Dr. Narendra Kochar told Reuters Health, "In post-TIPSS hepatic encephalopathy refractory to medical therapy and where patients are not liver transplant candidates, shunt modification can be effective in up to two thirds of patients."

To evaluate this procedure, Dr. Kochar of the Royal Infirmary of Edinburgh and colleagues examined data on 733 TIPSS insertions which took place over 14-year period. In all, 211 patients (29%) developed hepatic encephalopathy.

In 38 patients, shunt modification was performed. Occlusion was used in 29 and reduction in 9. Results were similar with either technique, and 58% of patients improved. The remainder were unchanged or worsened. Median survival in patients who improved was 278 days versus 79 days for those who did not.

Three patients died from liver-related complications following shunt occlusion.

Summing up, Dr. Kochar pointed out that "shunt occlusion may be associated with severe life-threatening complications, hence shunt reduction should be the preferred way of shunt modification."

Further research, he concluded, "is required to identify variables which would predict response to shunt modification."

Gut 2006;55:1617-1623.