Evaluation of upper endoscopic findings before and after Transjugular Intrahepatic Portosystemic Shunt in Egyptian Patients with Budd-Chiari Syndrome

Ahmed S Abdelmoaty ,Mohamed A Sakr ,Mohamed E Aboelmaaty ,Hend E Ebada

doi:10.21608/aeji.2020.45994.1107

Abstract

Background and study aim: Successful transjugular intrahepatic portosystemic shunt (TIPS) insertion effectively lowers the portosystemic pressure gradient, resolves ascites and improves esophageal varices, we studied the effect of TIPS on the grades of gastroesophageal varices and portal hypertensive gastropathy (PHG) in Egyptian patients with Budd-Chiari Syndrome (BCS). Patients and Methods: This prospective study was conducted at the Tropical Medicine Department; Ain Shams University on 20 patients with confirmed BCS with esophageal, gastric varices and PHG. Upper GI endoscopy was conducted before TIPS. Patients were followed up by upper GIT endoscopy at one and six months after TIPS. Results: After TIPS, there was a highly significant improvement of portal pressure, (before TIPS: Mean ±SD =24.9±1.9; after TIPS: 8.3±1.5, p-value <0.001) and esophageal varices (EV). In two of three patients with large EV within one-month post-TIPS and in all 3 patients within 6 months post TIPS. 15 patients with medium-sized EV markedly improved to 7 patients reduced to small EV and one reduced to non EV in one month and 9 patients to small EV and 6 reduced to non EV after 6 months and all 2 patients with small EV reduced to non EV after one and six months. After TIPS, there was a highly significant improvement of PHG in most cases. Conclusion: Successful TIPS insertion in BCS patients leads to improvement in esophageal varices & PHG.

Highlights

Budd-Chiari syndrome (BCS) is a rare but potentially life-threatening hepatic disorder results from obstruction of the hepatic venous outflow tract which can occur at any level from the hepatic venules to the right atrium [1].Abdominal Pain, associates, hepatosplenomegaly and portal hypertension are classic features of BCS
Our results showed that BCS more predominant in female patients than male patients (55% versus 45% respectively)
Factor V Leiden mutation (FVLM) was the most common cause and this was documented in 50% of patients

Summary

Introduction

Budd-Chiari syndrome (BCS) is a rare but potentially life-threatening hepatic disorder results from obstruction of the hepatic venous outflow tract which can occur at any level from the hepatic venules to the right atrium [1]. Abdominal Pain, associates, hepatosplenomegaly and portal hypertension are classic features of BCS. Most patients with BCS are found to have portal hypertensive gastropathy (PHG) together with esophageal varices (EV) with or without gastric varices (GV) [2]. Radiological imaging is enough to confirm a diagnosis of BCS. A liver biopsy is needed only if imaging not conclusive with high suspicious of BCS. Successful transjugular intrahepatic portosystemic shunt (TIPS) insertion effectively lowers the portosystemic pressure gradient, resolves ascites and improves esophageal varices, we studied the effect of TIPS on the grades of gastroesophageal varices and portal hypertensive gastropathy (PHG) in Egyptian patients with BuddChiari Syndrome (BCS)

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