Transjugular retrograde obliteration for chronic portosystemic encephalopathy

Abstract

Chronic portosystemic encephalopathy (CPSE) is uncommon, and its management has yet to be determined. We have been able to control five cases of CPSE using transjugular retrograde obliteration (TJO), and we report our clinical results with this technique. All of the five patients were suffering from cirrhosis and had gastric varices and large gastrorenal shunts. According to Sherlock's classification, the grade of encephalopathy was II in two patients, III in two, and IV in one. According to Child's classification, one had class B and four had class C cirrhosis. TJO was performed using a 6-F angiographic catheter with an occlusive balloon 20 mm in diameter. Absolute ethanol and 5% ethanolamine oleate with iopamidol were used to obliterate the gastrorenal shunt. The gastrorenal shunt was successfully obliterated, and the encephalopathy improved to grade 0 after TJO in all cases. The portal flow volume increased significantly from 542 +/- 189 to 992 +/- 139 mL/min (p < 0.01). The plasma ammonia levels before and after TJO were 189 +/- 40 and 51 +/- 23 microg/dL, and the indocyanine green retention rates at 15 min were 44 +/- 13% and 27 +/- 12%, with both changes being significant (p < 0.01). Minor complications observed were fever of over 38 degrees C and tarry stools due to hemorrhagic gastritis in one patient, which was being controlled conservatively. One patient died of hepatocellular carcinoma 27 months after TJO. The other four patients survived without recurrence of CPSE 17-74 months (44 +/- 24 months) after TJO. We conclude that TJO can be adopted as a safe and effective treatment for CPSE.

Emergency balloon-occluded retrograde transvenous obliteration for gastric varices

“…38,[45][46][47] It has also been considered that B-RTO could be a useful therapy for chronic hepatic encephalopathy. However, the NH 3 level was not changed significantly in the present study, and it is considered that this may have been due to some portosystemic shunt other than a gastrorenal shunt.…”

Percutaneous transhepatic obliteration and percutaneous transhepatic sclerotherapy for intractable hepatic encephalopathy and gastric varices improves the hepatic function reserve

“…Methods of shunt occlusion include surgical treatment and interventional radiology (IVR). When based on the direction of blood flow, IVR can be classified into two types, one including B-RTO (9-11) and transjugular retrograde obliteration for gastric varices (21,22), which are retrograde embolizations, and the other including transileocolic venous obliteration (23) and PTO (6), which are antegrade embolizations.…”

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

“…Several authors have reported the safety and efficacy of transcatheter embolization of portosystemic shunts in patients with refractory HE [13,[32][33][34][35][36][37][38]. In addition, in the previous 10 years, many case reports on HE due to portosystemic shunts that were successfully treated by transcatheter embolization have been published [17][18][19][20][21][22][23][39][40][41][42].…”

“…The details and outcomes of the reviewed studies are listed in Table 1 [13,[32][33][34][35][36][37][38].…”