Management of Transjugular Intrahepatic Portosystemic Shunt–Induced Refractory Hepatic Encephalopathy with the Parallel Technique: Results of a Clinical Follow-up Study

Abstract

To retrospectively evaluate the safety, feasibility, and midterm clinical outcome of the use of the parallel technique to treat transjugular intrahepatic portosystemic shunt (TIPS)-induced hepatic encephalopathy (HE) refractory to medical treatment. Additionally, factors potentially influencing clinical results after shunt reduction are assessed. Seventeen patients (11 men and 6 women) presenting with TIPS-induced HE refractory to medical treatment underwent shunt reduction with use of the parallel technique. West Haven HE grades before shunt reduction were IV and III in seven patients each and II in three patients. Mean portosystemic pressure gradient (PSPG) before shunt reduction was 6.8 mm Hg (range, 2-16 mm Hg). Relations between change in patients' mental state and several clinical parameters were analyzed. In all patients, it was technically feasible to reduce the shunt with use of the parallel technique. PSPG after reduction increased by a mean of 5.8 mm Hg (range, 1-12 mm Hg; P < .0001). Mental state grades with regard to HE after shunt reduction were 0 (n = 6), I (n = 4), II (n = 3), III (n = 1), and IV (n = 3). Clinical improvement (n = 7; 41%) or complete disappearance (n = 6; 35%) of HE occurred in 76% of the patients, which is statistically significant (P = .0002). No clear relation could be established between change in mental state regarding HE and any of the potentially influencing factors. Management of TIPS-induced HE with use of the parallel technique is feasible and safe. It results in an increase of PSPG, which is associated with an improvement in neuropsychiatric status in most patients.