Cognitive Impairment Predicts The Occurrence Of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt

Nardelli, Silvia; Gioia, Stefania; Pasquale, Chiara; Pentassuglio, I.; Farcomeni, Alessio; Merli, Manuela; Salvatori, Filippo Maria; Nikolli, Leandra; Torrisi, Sabrina; Greco, Francesca; Nicoletti, Valeria; Riggio, Oliviero

doi:10.1038/ajg.2016.29

Cited by 70 publications

(64 citation statements)

References 33 publications

(36 reference statements)

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“…The incidence of HE reported in the literature varies widely[3]. However, in our study, HE occurred at the same rate at the first year after TIPS creation.…”

Section: Discussionsupporting

confidence: 46%

“…The establishment of TIPS has been widely accepted as an alternative to surgery in the management of complications from portal hypertension, such as variceal bleeding, refractory ascites, Budd-Chiari syndrome, hepatorenal syndrome, hepatic hydrothorax and even hepatopulmonary syndrome[2]. After TIPS was introduced as an alternative treatment for complications related to portal hypertension, it has become progressively recognized as an effective therapeutic option in a growing number of clinical situations[3,4]. …”

Section: Introductionmentioning

confidence: 99%

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Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt

Luo¹,

Chu²,

Huang³

et al. 2017

WJG

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AIMTo evaluate the effect of initial stent position on transjugular intrahepatic portosystemic shunt (TIPS).METHODSWe studied 425 patients from January 2004 to January 2015 with refractory ascites or variceal bleeding who required TIPS placement. Patients were randomly divided into group A (stent in hepatic vein, n = 57), group B (stent extended to junction of hepatic vein and inferior vena cava, n = 136), group C (stent in left branch of portal vein, n = 83) and group D (stent in main portal vein, n = 149). Primary unassisted patency was compared using Kaplan-Meier analysis, and incidence of recurrence of bleeding, ascites and hepatic encephalopathy (HE) were analyzed.RESULTSThe mean primary unassisted patency rate in group B tended to be higher than in group A at 3, 6 and 12 mo (P = 0.001, 0.000 and 0.005), and in group D it tended to be lower than in group C at 3, 6 and 12 mo (P = 0.012, 0.000 and 0.028). The median shunt primary patency time for group A was shorter than for group B (5.2 mo vs 9.1 mo, 95%CI: 4.3-5.6, P = 0.013, log-rank test), while for group C it was longer than for group D (8.3 mo vs 6.9 mo, 95%CI: 6.3-7.6, P = 0.025, log-rank test). Recurrence of bleeding and ascites in group A was higher than in group B at 3 mo (P = 0.014 and 0.020), 6 mo (P = 0.014 and 0.019) and 12 mo (P = 0.024 and 0.034. Recurrence in group D was higher than in group C at 3 mo (P = 0.035 and 0.035), 6 mo (P = 0.038 and 0.022) and 12 mo (P = 0.017 and 0.009). The incidence of HE was not significantly different among any of the groups (P = 0.965).CONCLUSIONThe initial stent position can markedly affect stent patency, which potentially influences the risk of recurrent symptoms associated with shunt stenosis or occlusion.

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“…The incidence of HE reported in the literature varies widely[3]. However, in our study, HE occurred at the same rate at the first year after TIPS creation.…”

Section: Discussionsupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt

Luo¹,

Chu²,

Huang³

et al. 2017

WJG

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“…32 Different trials investigated the main risk factors of post-TIPS HE which are: history of previous HE, older age, high creatinine levels, low serum sodium and low albumin values, 34 low Portacaval Pressure Gradient (PPG) and Child-Pugh score. 35,36 Two recent studies demonstrated that also minimal HE 37 and sarcopenia pre-TIPS 38 have a strong impact on overt HE development after TIPS placement.…”

Section: Hepatic Encephalopathy After Transjugular Intrahepatic Portomentioning

confidence: 99%

Radiological Intervention for Shunt Related Encephalopathy

Nardelli

Gioia

Riggio

2018

Journal of Clinical and Experimental Hepatology

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Hepatic Encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Several clinical and pathophysiologic observations suggest the importance of portal-systemic shunts in the development of HE. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment. This latter type of HE should be related to spontaneous or radiological (such as Transjugular Intrahepatic Portosystemic Shunt (TIPS)) portal systemic shunts, that could be restricted or occluded in patients with chronic HE. Both TIPS reduction and shunt occlusion are radiological procedures, safe and effective to ameliorate neurological symptoms in patients with refractory HE. ( J CLIN EXP HEPATOL 2018;8:452-459) PORTOSYSTEMIC SHUNTS IN CIRRHOSIS-CLASSIFICATION, TYPES, CLINICAL IMPLICATIONS, NATURAL HISTORY SPSSs are, as the name implies, potential communications between the portal venous system and the systemic venous circulation than can open and grow when portal pressure increases. These SPSS act as "release valves" to reduce the portal pressure, but also act as bypasses to normal liver flow. At one point, the shunt becomes large enough that it starts contributing to the progression of the liver disease. 8 The main types of SPSSs are: paraumbilical vein, splenorenal, splenoiliac with internal hemorrhoids, esophageal varices and gastrocaval, indirect gastrocaval, gastrorenal associated with gastric varices. 8 SPSSs can be classified into left-sided and right-sided (central) shunts; the most frequent right-side shunt is represented by recanalization of paraumbilical vein, while the most common left-sided shunts are gastrorenal shunt, observed in 85% of patients with gastric varices, gastrocaval shunt and splenorenal shunt. The clinical manifestations of these latter shunts comprise gastric variceal bleeding, HE and portal vein

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“…Twenty-five were analysed ( Figure 1). The main characteristics are listed in Table 1: median age was 59 years, male gender 76%, median Child-Pugh score = 8 [5][6][7][8], median MELD score = 12 [9][10][11][12][13][14][15][16][17]…”

Section: Clinical Evaluation Before Tipss Placementmentioning

confidence: 99%

“…Prevalence of overt hepatic encephalopathy (OHE) after TIPSS varies among series, reaching up to 50% in older studies where bare TIPSS were placed. 1 With the almost exclusive use of covered stents, this prevalence has decreased but still ranges between 20% and 30% at 1 year, in both controlled [2][3][4][5][6][7] and observational studies. 8,9 A metaanalysis showed that this prevalence was higher after TIPSS than in control group, that is, patients who did not undergo TIPSS placement.…”

Section: Introductionmentioning

confidence: 99%

Combined diffusion tensor imaging and magnetic resonance spectroscopy to predict neurological outcome before transjugular intrahepatic portosystemic shunt

Rudler

Weiss

Perlbarg³

et al. 2018

Aliment Pharmacol Ther

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Cognitive Impairment Predicts The Occurrence Of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt

Abstract: Psychometric evaluation before TIPS is able to identify most of the patients who will develop HE after a TIPS and can be used to select patients in order to have the lowest incidence of this important complication.

Cited by 70 publications

References 33 publications

Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt

Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt

Radiological Intervention for Shunt Related Encephalopathy

Combined diffusion tensor imaging and magnetic resonance spectroscopy to predict neurological outcome before transjugular intrahepatic portosystemic shunt

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