Modification of splenic stiffness on acoustic radiation force impulse parallels the variation of portal pressure induced by transjugular intrahepatic portosystemic shunt

Santis, Adriano De; Nardelli, Silvia; Bassanelli, C.; Lupo, M.; Iegri, C.; Ciesco, Carmela Anna Di; Forlino, Mariana; Farcomeni, Alessio; Riggio, Oliviero

doi:10.1111/jgh.13907

“…Within these concepts it is important to be aware of patient safety in the course of TIPS modification, particularly regarding the recurrence of the primary TIPS indication, especially variceal bleeding and ascites [19,20,86,87]. Recent main studies analyzing the effect of shunt modification in patients with refractory post-TIPS HE are summarized in Table 4 [4,19,66,[87][88][89]. While shunt reduction at the time of the pivotal study by Kochar et al was still a technical challenge, today, ready-to-use reduction stents offer the opportunity to easily downsize the shunts in a standardized manner [86,87,89].…”

Section: Management and Outcome Of Post-tips Hementioning

confidence: 99%

Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges

Schindler

¹

,

Heinzow

²

,

Trebicka

³

et al. 2020

JCM

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Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment tool in decompensated liver cirrhosis that has been shown to prolong transplant-free survival. Hepatic encephalopathy (HE) is a frequent complication of decompensated cirrhosis, eventually induced and/or aggravated by TIPS, that remains a clinical challenge especially in these patients. Therefore, patient selection for TIPS requires careful assessment of risk factors for HE. TIPS procedural parameters regarding stent size and invasive portosystemic pressure gradient measurements thereby have an important role. Endovascular shunt modification, in combination with a conservative medical approach, often results in a significant reduction of symptoms. This review summarizes HE molecular mechanisms and pathophysiology as well as diagnostic and therapeutic approaches targeting shunt-induced HE.

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“…There are a few studies with small sample sizes that applied TE, ARFI, and pSWE focus on the evaluation of hemodynamic change after TIPS placement [15][16][17][18]. They all successfully demonstrated that SS showed the best diagnostic utility in reflecting the hemodynamic change after TIPS implantation compared with other noninvasive methods.…”

Section: Discussionmentioning

confidence: 99%

“…They all successfully demonstrated that SS showed the best diagnostic utility in reflecting the hemodynamic change after TIPS implantation compared with other noninvasive methods. However, there were some characteristics and limitations as follows: (1) the main objectives of early studies were not the severity of GEVs in the post-TIPS follow-up; (2) above elastography technology application and reliability are limited by obesity and ascites [13,14]; (3) the small sample sizes and single-center characteristics had appreciable impact on the representativeness of the conclusion [15][16][17][18]; (4) just one of the former trials was conducted until 12 months after shunt placement [16]. Additionally, the cutoff values from TE, ARFI, and pSWE could not be directly applied to 2D-SWE examinations [27].…”

Section: Discussionmentioning

confidence: 99%

“…However, among above studies, lots of participants with compensated advanced chronic liver disease did not undergo stent implantation; additionally, above elastography technologies obtained a lower success rate in patients with ascites, obesity, or narrow intercostal windows [13,14]. Until now, only a few trials with small sample sizes were used to assess the hemodynamic change after TIPS placement [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Spleen Stiffness Performance in the Noninvasive Assessment of Gastroesophageal Varices after Transjugular Intrahepatic Portosystemic Shunts

Zhou

¹

,

Zhang

²

,

Zhang

³

et al. 2021

BioMed Research International

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Objectives. To investigate the performance of spleen stiffness (SS) by using two-dimensional shear-wave elastography (2D-SWE) for assessing the severity of gastroesophageal varices (GEVs) after transjugular intrahepatic portosystemic shunt (TIPS). Methods. 102 eligible patients were categorized as in the post-TIPS short-term ( n = 69 ) and long-term ( n = 38 ) follow-up groups. The performance of SS by using 2D-SWE for evaluating the severity of GEVs was compared with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), liver stiffness spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension (PH) risk score, platelet count-to-spleen diameter ratio (PSR), and varices risk score by using receiver operating characteristic (ROC) curve and DeLong test. Results. In the post-TIPS short-term follow-up group, area under the receiver operating characteristic curves (AUCs) of SS were 0.585 for mild ( cutoff value = 30.3 kPa), 0.655 for moderate ( cutoff value = 30.6 kPa), and 0.739 for severe ( cutoff value = 31.9 kPa) GEVs, which were higher than other parameters for severe GEVs. AUCs of SS were lower than other parameters for mild and moderate GEVs, but no difference was found ( p > 0.05 ). In the post-TIPS long-term follow-up group, AUCs of SS were 0.778 for mild ( cutoff value = 28.9 kPa), 0.82 for moderate ( cutoff value = 29.9 kPa), and 0.824 for severe ( cutoff value = 37.7 kPa) GEVs, which were higher than other parameters except for severe GEVs. AUC of SS was lower than other parameters for severe GEVs, but no significant difference was found ( p > 0.05 ). Conclusion. SS is an effective noninvasive tool to predict GEV severity during the post-TIPS follow-up.

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“…This work makes SS a potential noninvasive method to evaluate portal hypertension. Therefore, further investigations are needed to establish the applicability of SS in the management of portal hypertension [32]. However, no study has revealed the relation between SS and survival after TIPS.…”

Section: Discussionmentioning

confidence: 99%

Spleen Stiffness Predicts Survival after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients

Zhu

¹

,

Guo

²

,

Yin

³

et al. 2020

BioMed Research International

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Objectives. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications. Little is known about the ability of spleen stiffness (SS) for predicting the survival of cirrhotic patients undergoing TIPS. This study is to evaluate the influence of SS detected by point shear wave elastography (pSWE) in predicting survival after TIPS. Methods. This retrospective cohort study screened consecutive patients who underwent TIPS and reliable pSWE measurement between October 2014 and September 2017 from our prospectively maintained database. SS values were measured before TIPS. The primary endpoint was the overall survival after TIPS. The Cox regression analysis model was used for univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to calculate the sensitivity, specificity, and positive and negative predictive values. Results. A total of 89 patients were involved in the final analysis. 24 patients (27.0%) died during a median follow-up time of 31 m. Multivariable Cox regression analysis confirmed that higher SS value ( P < 0.001 ), LS value ( P = 0.008 ), diameter of shunt ( P = 0.001 ), and older age ( P < 0.001 ) were independent prognostic factors of survival after TIPS. The risk of death rose 57.440-fold for each SS unit (m/s) increase. SS was also correlated with liver failure after TIPS. ROC analysis showed that the best SS cutoff value was 3.60 m/s for predicting survival, with a sensitivity of 54.2% and specificity of 90.8%. Conclusions. The SS value determined by pSWE in cirrhotic patients was an independent predictive factor for survival after TIPS.

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Modification of splenic stiffness on acoustic radiation force impulse parallels the variation of portal pressure induced by transjugular intrahepatic portosystemic shunt

Cited by 25 publications

References 42 publications

Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges

Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges

Spleen Stiffness Performance in the Noninvasive Assessment of Gastroesophageal Varices after Transjugular Intrahepatic Portosystemic Shunts

Spleen Stiffness Predicts Survival after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients

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