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

Abstract

PURPOSE:

To evaluate the efficacy and intermediate-term outcome of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hepatic encephalopathy (HE) secondary to portosystemic shunt (PSS) in cirrhotic patients.

MATERIALS AND METHODS:

Institutional review board (IRB) approval was obtained for this study and hospital records of patients who underwent BRTO, from August 2011 to August 2015, were analyzed. Based on the inclusion and exclusion criteria, 39 patients (age, 54.07 ± 9.1 years (37-67 years); 33 males and 6 females) with cirrhosis and spontaneous PSS were included. Clinical and laboratory parameters and HE grade were evaluated in all patients before and after the procedure.

RESULTS:

Forty sessions of BRTO were attempted in 39 patients. Follow-up imaging revealed complete obliteration of the treated PSS in all patients with clinical success in 37 patients (94.9%). The 1-, 2-, 3-, 4-, 5-, 6-, and 7-year HE-free survival rates among responders were 91.7%, 91.7%, 88.8%, 85.5%, 80.8%, 80.8%, and 80.8% respectively and overall survival rates were 89.7%, 82.1%, 76.9%, 74.4%, 74.4%, 64.8%, and 64.8% respectively. Logistic regression highlighted Child-Turcotte-Pugh (CTP) score at 6 months as a positive predictive factor of HE recurrence with a cutoff of ≥ 9. Five patients (12.8%) had fever and leukocytosis and 1 (2.6%) patient developed spontaneous bacterial peritonitis after the procedure.

CONCLUSION:

BRTO is an effective treatment for refractory HE in cirrhotics secondary to large PSS with a few possible complications.

KEY POINTS:

• BRTO is an effective and safe treatment for refractory HE, arising from PSS in cirrhotic patients. • Patients with preserved liver function show better outcome and CTP score is the most important predictor of relapse during follow-up.

• Authors: Amar Mukund, Lakshmi Kumar Chalamarla, Nishant Singla, Saggere Muralikrishna Shasthry, Shiv Kumar Sarin
• Journal: European radiology (Eur Radiol) Vol. 30 Issue 6 Pg. 3462-3472 (Jun 2020) ISSN: 1432-1084 [Electronic] Germany
• PMID: 32048037 (Publication Type: Journal Article)

Chemical References

• Sclerosing Solutions
• Sodium Tetradecyl Sulfate

Topics

• Adult
• Aged
• Balloon Occlusion (methods)
• Esophageal and Gastric Varices (etiology)
• Female
• Hepatic Encephalopathy (etiology, therapy)
• Humans
• Hypertension, Portal (complications)
• Liver Cirrhosis (complications)
• Male
• Middle Aged
• Recurrence
• Renal Veins
• Retrospective Studies
• Sclerosing Solutions (therapeutic use)
• Sodium Tetradecyl Sulfate (therapeutic use)
• Splenic Vein
• Survival Rate
• Tomography, X-Ray Computed
• Treatment Outcome