Comparison of patients with hepatic encephalopathy and those with gastric varices before and after balloon‐occluded retrograde transvenous obliteration

Ishikawa, Tsuyoshi; Sasaki, Ryo; Nishimura, T.; Matsuda, Takashi; Maeda, Masaki; Iwamoto, Takuya; Saeki, Issei; Hidaka, Isao; Takami, Taro; Sakaida, Isao

doi:10.1111/hepr.13199

Cited by 21 publications

(27 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 It has also showed effectiveness as treatment of HE associated with GVs. 83 However, the secondary increase in PVP can worsen other PH-related complications, as EVs or ascites. Moreover, the sclerosing material could also produce secondary effects, as pulmonary edema or portal vein thrombosis.…”

Section: Embolizationmentioning

confidence: 99%

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

View full text Add to dashboard Cite

Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.

show abstract

Section: Embolizationmentioning

confidence: 99%

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Regarding portal-hypertension-related diseases, IR treatments raise serious post-therapeutic concerns that include the emergence of ascites, deterioration of other varices, portal thrombosis, and liver failure [16,17]. Although each modality has drawbacks, recent US and 4D flow MRI studies have revealed the relationship between portal flow and the deterioration of gastroenteric varices and liver function [2,[18][19][20]. IR treatments can alter the flow dynamics of the portal circulation between pre-and post-therapy, resulting in changed liver function [18,20].…”

Section: Introductionmentioning

confidence: 99%

Visualization of flow dynamics in the portal circulation using 320-detector-row computed tomography: a feasibility study

et al. 2021

View full text Add to dashboard Cite

Multidetector row computed tomography (CT) scanners perform dynamic scanning and have a wide scan range. Time-resolved three-dimensional CT (i.e., 4D CT) has recently enabled visualization of flow in neurovascular vessels. We hypothesized that 4D CT technology would be a useful and non-invasive method for visualizing the flow dynamics of the portal circulation. The aim of this study was to evaluate the technical feasibility of 4D CT for visualizing flow dynamics in the portal circulation using 320-detector-row CT. 4D CT images of 18 consecutive patients with portal circulation including gastrorenal shunt were retrospectively evaluated for their ability to generate flow dynamics of the portal circulation. Flow dynamics could be visualized by 4D CT in 68 of the 72 vessels in the portal vein, splenic vein, superior mesenteric vein, and gastrorenal shunt. Flow direction could not be identified in four vessels, all of them being superior mesenteric veins. Flow direction was recognized on 4D CT in the 68 vessels of the portal circulation. A preliminary validation study revealed that flow direction of all 19 vessels in the portal circulation had concordance between 4D CT and color Doppler ultrasound. 4D CT could visualize flow dynamics of the portal circulation.

show abstract

“…[6][7][8][9] Our previous study demonstrated that patients with encephalopathy showed more dramatic hemodynamic changes in the portal-splenic venous system following PSS occlusion compared with those with gastric varices, leading to more significant reductions in both the Child-Pugh and MELD-Na scores in the former patient group. 2 We additionally reported that lower pretreatment LS measured by transient elastography could be predictive of improvements being more significant in hepatic function and long-term outcomes of patients with portal hypertension undergoing BRTO. 3 According to the results of our original studies, 2,3 we recently proposed the novel concept, "portal-systemic liver failure," which might be a reversible pathology and could be expected to be ameliorated by occlusion of PSSs.…”

Section: Discussionmentioning

confidence: 81%

“…1 In addition, we reported that PSS occlusion could potentially prolong the prognosis of such patients with low liver stiffness (LS) and refractory encephalopathy by improving the hepatic reserve and fibrosis. [1][2][3] Thus, balloon-occluded retrograde transvenous obliteration (BRTO) has been believed to improve not only the gastric fundal varices and hepatic encephalopathy related to PSSs [4][5][6] but also liver function and long-term patient outcomes. [7][8][9] However, the procedure can result in severe complications and hepatic functional deterioration due to the elevated portal venous pressure (PVP) following major shunt occlusion, leading to worse prognosis postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Significant improvement in portal‐systemic liver failure symptoms and successful management of portal‐splenic venous hemodynamics by the combination of interventional radiology and pharmacotherapy

Ishikawa

Hamamoto

Sasaki

et al. 2020

Hepatology Research

Self Cite

View full text Add to dashboard Cite

This study describes a case of hepatitis C virus-related decompensated cirrhosis with portal-systemic liver failure and refractory encephalopathy. It was successfully managed with a combination of interventional radiology and pharmacotherapy, to improve hepatic function, including hyperammonemia and to control portal-splenic venous hemodynamics with hepatic venous pressure gradient (HVPG) monitoring. A man in his late 50s presented with a Child-Pugh score of 13, Model for End-Stage Liver Disease-sodium (MELD-Na) score of 19 and blood ammonia level of 185 μg/dL. He underwent balloon-occluded retrograde transvenous obliteration (BRTO) followed by partial splenic embolization (PSE) and non-selective beta-blocker (NSBB) administration. BRTO induced drastic changes in the portal-splenic venous hemodynamics, resulting in dramatically improved hepatic function and reduced hyperammonemia. However, the procedure resulted in increased HVPG from 13.6 mmHg at baseline to 23.5 mmHg at 1-month post-BRTO, accompanied by ascites retention and development of portal hypertensive gastropathy. Thereafter, PSE was performed, followed by NSBB administration, to control the elevated portal venous pressure following BRTO. Postoperatively, the patient's ascites and portal hypertensive gastrophy improved after splenic artery embolization, which eventually disappeared after the additional administration of NSBBs 1 month later. The HVPG finally decreased to 16.9 mmHg; the Child-Pugh score, MELD-Na score and blood ammonia level improved to 7, 11 and 22 μg/dL, respectively, after all therapies. BRTO significantly improved the symptoms of portal-systemic liver failure with refractory encephalopathy. PSE and NSBB administration could contribute to additional amelioration of hepatic function and successful management of complications induced by portal hemodynamic changes following BRTO.

show abstract

Comparison of patients with hepatic encephalopathy and those with gastric varices before and after balloon‐occluded retrograde transvenous obliteration

Abstract: The HE patients showed distinct portal-splenic hemodynamics before and after BRTO. Balloon-occluded retrograde transvenous obliteration markedly improved hepatic function in the HE group compared with the GV group.

Cited by 21 publications

References 29 publications

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Visualization of flow dynamics in the portal circulation using 320-detector-row computed tomography: a feasibility study

Significant improvement in portal‐systemic liver failure symptoms and successful management of portal‐splenic venous hemodynamics by the combination of interventional radiology and pharmacotherapy

Contact Info

Product

Resources

About