Effect of Spontaneous Portosystemic Shunts on Hemorrhage from Esophagogastric Varices

Hsieh, Jan-Sing; Wang, Jaw‐Yuan; Huang, Che-Jen; Chen, Fang‐Ming; Huang, Tsung-Jen

doi:10.1007/s00268-003-7068-7

Cited by 13 publications

(1 citation statement)

References 13 publications

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“…The major mechanism is that the blood flow is redirected from the high-pressure portal vessels to the low-pressure systemic vessels [2]. In nature, spontaneous portosystemic shunt is a compensation for portal hypertension [3,4]. However, great damage is caused by the overgrowth of portosystemic shunts.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Spontaneous Splenorenal Shunt in Liver Cirrhosis: A Retrospective Observational Study Based on Contrast-Enhanced Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) Scans

Zhang

et al. 2017

Med Sci Monit

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BackgroundThis is a retrospective observational study evaluating the prevalence and clinical characteristics of spontaneous splenorenal shunt in liver cirrhosis.Material/MethodsWe included a total of 105 cirrhotic patients who were admitted to our hospital between June 2012 and December 2013 and underwent contrast-enhanced CT and/or MRI scans at admissions. Spontaneous splenorenal shunt was identified. Clinical and laboratory data were compared between cirrhotic patients with and without spontaneous splenorenal shunt.ResultsThe prevalence of spontaneous splenorenal shunt was 10.5% (11/105). The prevalence of hepatic encephalopathy was higher in patients with spontaneous splenorenal shunt than in those without spontaneous splenorenal shunt (18.2% vs. 4.3%, p=0.062), but the difference between them was not statistically significant. The prevalence of acute upper-gastrointestinal bleeding was lower in patients with spontaneous splenorenal shunt than in those without spontaneous splenorenal shunt (0% vs. 18.1%, p=0.205), but the difference between them was not statistically significant. Patients with spontaneous splenorenal shunt had significantly higher Child-Pugh scores (9.50±1.65 vs. 7.43±2.02, p=0.002) and MELD scores (11.26±7.29 vs. 5.67±6.83, p=0.017) than those without spontaneous splenorenal shunt. In-hospital mortality was similar between them (0% vs. 4.3%, p=1.000).ConclusionsSpontaneous splenorenal shunt might be associated with worse liver function in liver cirrhosis, but not with in-hospital mortality.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Spontaneous Splenorenal Shunt in Liver Cirrhosis: A Retrospective Observational Study Based on Contrast-Enhanced Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) Scans

Zhang

et al. 2017

Med Sci Monit

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Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy

et al. 2013

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Refractory hepatic encephalopathy (HE) remains a major cause of morbidity in cirrhosis patients. Large spontaneous portosystemic shunts (SPSSs) have been previously suggested to sustain HE in these patients. We aimed to retrospectively assess the efficacy and safety of patients treated with embolization of large SPSSs for the treatment of chronic therapy-refractory HE in a European multicentric working group and to identify patients who may benefit from this procedure. Between July 1998 and January 2012, 37 patients (Child A6-C13, MELD [Model of Endstage Liver Disease] 5-28) with refractory HE were diagnosed with single large SPSSs that were considered eligible for embolization. On a short-term basis (i.e., within 100 days after embolization), 22 out of 37 patients (59.4%) were free of HE (P < 0.001 versus before embolization) of which 18 (48.6% of patients overall) remained HE-free over a mean follow-up period of 697 6 157 days (P < 0.001 versus before embolization). Overall, we noted improved autonomy, decreased number of hospitalizations, and severity of the worst HE episode after embolization in three-quarters of the patients. Logistic regression identified the MELD score as strongest positive predictive factor of HE recurrence with a cutoff of 11 for patient selection. As to safety, we noted one major nonlethal procedure-related complication. There was no significant increase in de novo development or aggravation of preexisting varices, portal hypertensive gastropathy, or ascites. Conclusion: This multicenter European cohort study demonstrated a role for large SPSSs in chronic protracted or recurrent HE and substantiated the effectiveness and safety of embolization of these shunts, provided there is sufficient functional liver reserve. (HEPATOLOGY 2013;57:2448-2457 H epatic encephalopathy (HE) is a major complication of cirrhosis and refers to potentially reversible alterations in autonomy, consciousness, behavior, and psychomotor functions related to an accumulation of toxins due to hepatocellular dysfunction and portosystemic shunting.1-5 While in some patients HE is initiated abruptly by a precipitating event such as infection or gastrointestinal bleeding (the so-called episodic HE), other patients have persistent HE characterized by continuous high levels of ammonia, chronic electrophysiological abnormalities, and recurrent or persistent incapacitating alterations in mental status, often without evident precipitating events. 1,3,4 In this latter group, medical treatment is Abbreviations: EASL-CLIF, European Association for the Study of the Liver -Consortium on Chronic Liver Insufficiency; HE, hepatic encephalopathy; MELD, Model of Endstage Liver Disease; mRS, modified Rankin Scale; SPSS, spontaneous portosystemic shunt; SRS, splenorenal shunt; TIPS, transjugular intrahepatic portosystemic shunt.From the

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Intractable hepatic encephalopathy in cirrhotic patients: mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration

et al. 2020

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Effect of Spontaneous Portosystemic Shunts on Hemorrhage from Esophagogastric Varices

Cited by 13 publications

References 13 publications

Prevalence and Clinical Characteristics of Spontaneous Splenorenal Shunt in Liver Cirrhosis: A Retrospective Observational Study Based on Contrast-Enhanced Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) Scans

Prevalence and Clinical Characteristics of Spontaneous Splenorenal Shunt in Liver Cirrhosis: A Retrospective Observational Study Based on Contrast-Enhanced Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) Scans

Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy

Intractable hepatic encephalopathy in cirrhotic patients: mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration

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