3:00 PM Abstract No. 381 - Percutaneous transumbilical embolization of spontaneous portosystemic shunts for the treatment of hepatic encephalopathy

Abstract

To evaluate the safety and efficacy of percutaneous transumbilical embolization (PTE) of spontaneous portosystemic shunts (SPSSs) for the treatment of hepatic encephalopathy (HE). The medical records of seven cirrhotic patients (sex, four men and three women; mean age, 63.2 ± 3.9 years) who underwent PTE of SPSSs for the treatment of HE at our institution between January 2012 and August 2016 were reviewed. The etiologies of cirrhosis were hepatitis B virus (n = 4), alcoholic liver disease (n = 2), and primary biliary cholangitis (n = 1). The mean Model for End-Stage Liver Disease score was 13.1 ± 3.4. All patients had overt HE. The median grade of HE was 2 (range, 2–3). Six (85.7%) patients had persistent HE and one (14.3%) had recurrent HE. The median number of episodes of overt HE within 6 months was 4 (range, 2–4). Technical success was achieved in 100% (7/7) of patients. All patients had complete resolution (n = 4) or improvement (n = 3) of signs and symptoms of HE within 3 days after procedure, rendering a clinical success rate of 100% (7/7). The median grade of HE 3 days after the procedure was 1 (range, 0–1). The grade of HE was significantly decreased 3 days after the procedure (p = 0.016). Development of new esophageal varices, a major complication, occurred in one (14.3%) patient 3 days after the procedure. The median follow-up period after the procedure was 43 (range, 5–111) months. Recurrence occurred in 71.4% (5/7) of patients in a median time of 13 (range, 1–49) months. Two (28.6%) patients had recurrence within 6 months. The remaining five (71.4%) patients remained free of recurrence for a median time of 37 (range, 10–49) months. The number of episodes of OHE within 6 months was significantly lower after the procedure (p > 0.017). PTE of SPSSs may be safe and effective for the treatment of HE. It may be considered for patients with recurrent and persistent HE in the setting of recanalized paraumbilical vein.