Letter: transjugular intrahepatic portosystemic shunt for the treatment of Budd-Chiari syndrome in China.

Abstract

A single-centre retrospective study by Tripathi et al. further confirmed an excellent outcome of transjugular intrahepatic portosystemic shunt (TIPSS) for the treatment of Budd–Chiari syndrome (BCS).1 Notably, the cases enrolled into this study appeared to be a subgroup of data from a European multi-centre study,2 and an extended group of data from a previous study by the same study team.3 Thus, the conclusions of this study were very similar to those of previous studies, such as shunt patency and survival.4 However, due to potential differences in the obstructive location and aetiological distribution of BCS between China and Western countries,5-7 whether Western experiences in the treatment of BCS should be extrapolated to Chinese BCS patients remains unclear. In China, percutaneous recanalisation is the most common treatment modality of BCS, with TIPSS rarely employed. Several large case series have demonstrated that the percutaneous recanalisation without TIPSS could achieve an excellent outcome in most Chinese patients with BCS.8, 9 Of course, the role of TIPSS should not be neglected in Chinese BCS patients. Before the publication by Tripathi et al.,1 we reported the results of TIPSS for the treatment of BCS in 51 Chinese patients and suggested that TIPSS was worthy of consideration in Chinese BCS patients.10 Compared with Western studies, our study had several remarkable characteristics. First, a larger proportion of cases received percutaneous recanalisation before TIPSS, especially those undergoing a prior inferior vena cava stent placement, which greatly increased the technical difficulty of TIPSS. Second, covered stents did not significantly decrease the incidence of shunt dysfunction, but increased the risk of hepatic encephalopathy. Finally, the prognosis of BCS was similar between early and converted TIPSS groups. Similarly, our study also supported the use of BCS-TIPSS score in predicting the prognosis of BCS patients undergoing TIPSS. Declaration of personal and funding interests: None.