Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for reducing portal pressure. Hepatic myelopathy (HM), a rare complication of chronic liver diseases, remains obscure in terms of treatment and prognosis. We aimed to determine an optimal treat strategy for patients with HM after TIPS. Twenty-nine patients who developed HM after TIPS were stratified by time-lapse from onset to treatment: group A (n = 16), <6 months; group B (n = 13), ≥6 months. Therapeutic measures included shunt-limiting and medical treatments. Overall survival, lower-limb muscle strength, Fugl-Meyer score, Barthel index, and serum ammonia were recorded. Median survival time in group A or B was 30 months or 16.5 months, respectively (log rank p = 0.0172). All patients in group A obtained improvement in grading of muscle strength (p < 0.0001), Fugl-Meyer score (p = 0.0021), and Barthel index (p = 0.0003), particularly male patients and those subjected to shunt-limiting. Serum ammonia levels were decreased significantly in both group A (p = 0.0007) and group B (p = 0.0007). Collectively, once HM is confirmed after TIPS, active intervention is imperative and urgent, especially within the first 6 months from onset of symptom. TIPS shunt-limiting is particularly beneficial for rehabilitation in patients with early-onset HM.
Highlights
Aside from conservative medical management, we attempted to rectify consequences of original Transjugular intrahepatic portosystemic shunt (TIPS) procedures by placement of reducing stents
In the course of this study, we focused on changes in perioperative conditions of patients subjected to stent-limiting procedures
General awareness of post-TIPS complications has grown with worldwide application of TIPS
Summary
36 patients with HM were identified for this retrospective study. Patients with HM accounted for 1.04% (36/3467) of all patients undergoing TIPS during the study period. In group B, significant changes in PSG were recorded from 13 patients (from 8.39 ± 0.65 to 9.46 ± 1.2 mmHg; t = 3.482; p = 0.0045); especially in male patients (from 8.4 ± 0.7 to 9.6 ± 1.08 mmHg; t = 4.811; p = 0.001); and in stent-limiting treatment recipients (from 8.38 ± 0.74 to 9.25 ± 1.17 mmHg; t = 2.497; p = 0.0412) but not in medical therapy recipients (from 8.4 ± 0.55 to 9.8 ± 1.3 mmHg; t = 2.333; p = 0.08). Patients in group A had experienced significant improvement than group B in terms of lower-limb muscle strength, physical activity, and Barthel ADL index. In group B, male patients and those receiving stent-limiting treatments obtained significant improvement on muscle strength. Lower-limb Fugl-Meyer and Barthel scores were similar in group B (Figs 4, 5 and 6)
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