Abstract No. 122 Biliary complications after trans-jugular intrahepatic portosystemic shunt placement

Abstract

To investigate the incidence of biliary complications after TIPSS procedure The institutional review board approved this study and informed consent was waived. 443 patients with liver cirrhosis and portal hypertension underwent TIPSS placement between January of 2010 and December of 2018. Baseline characteristics of the patients including age, sex, indication of TIPSS, and MELD scores were recorded. All cross-sectional imaging performed within two years after the TIPSS were reviewed and compared with the pre-TIPSS images. All cases with new post-TIPSS intrahepatic biliary duct dilatation were included. Patients with no follow up imaging, baseline biliary duct dilatation, transplanted, or died within a month of the TIPSS were excluded. Clinical and lab findings of the patients with new post-TIPSS biliary dilatation were recorded. 216 patients were excluded. A total of 227 patients were included. 40 patients encountered a new post-TIPSS biliary duct dilatation (17.6%). Biliary duct dilatation was noted mostly in segment 6 and 7 in close proximity of the TIPSS stent-graft. Only 6 cases (2.64%) were significant dilatation by imaging. Only one patient required intervention for biloma that required a drain. Lab changes were noted but it was not obvious if that was related to liver function deterioration after TIPSS or to the biliary dilatation. Biliary complications are very rare after TIPSS procedures. Only one patient in this cohort developed biloma related to hepatic necrosis and that required drain. Intra-hepatic biliary duct dilatation, however, is a common phenomena after TIPSS that likely related to external pressure from the adjacent TIPSS material. No clinical impact of post TIPSS biliary duct dilatation was noted in this study.