Abstract
BackgroundTo evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS).MethodsWe retrospectively reviewed 9 consecutive patients with GS-related HSOS who were refractory to supportive treatment and underwent TIPS at our institution between January 2014 and September 2019. The patients were evaluated for safety and efficacy, including TIPS complications and changes in portosystemic pressure gradient (PPG), ascites, total bilirubin, liver size and portal vein diameter.ResultsTIPS procedures were performed successfully in the 9 patients, and no technically-related complications due to the TIPS procedure were recorded. The PPG was improved by TIPS in all patients (mean PPG before TIPS, 30.4 ± 5.2 vs. 13.0 ± 4.1 mm Hg post-TIPS, P = 0.008). One patient who was lost to follow-up, whereas the remaining 8 patients survived with a median follow-up period of 12 months (range 5–39 months). Although the total bilirubin was significantly increased 5–7 days after TIPS compared with that before the procedure (3.57 ± 1.58 vs. 4.82 ± 2.06 mg/dl, P = 0.017), it returned to baseline levels at 1-month follow-up (3.53 ± 2.72 vs. 4.82 ± 2.06 mg/dl, P = 0.401). The patients experienced complete resolution or noticeable reduction of ascites (P < 0.001), significant reduction of liver size (16.7 ± 2.2 vs. 13.7 ± 1.7 cm, P = 0.018), and significant enlargement of the portal trunk (10.7 ± 2.5 vs. 13.4 ± 2.4 mm, P = 0.017) after TIPS compared to the pre-TIPS state.ConclusionTIPS may offer a potentially useful treatment for the GS-related HSOS.
Highlights
To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS)
All patients had the history of GS intake and presented with hepatomegaly, jaundice and ascites, with characteristic findings of HSOS on CT images (Fig. 2a, b)
Another retrospective study by Zhuge et al [9] compared the efficacy of anticoagulation with or without TIPS and supportive treatment for GS-related HSOS and found that anticoagulation noticeably improved the survival rate and TIPS further improved the prognosis of patients who did not respond to anticoagulation therapy
Summary
To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS). Hepatic sinusoidal obstruction syndrome (HSOS), previously called hepatic veno-occlusive disease, refers to obstruction of hepatic venous outflow at the level of the. Current therapies for the GS-related HSOS focus on supportive care and anticoagulation. Transjugular intrahepatic portosystemic shunt (TIPS) has been used to treat HSOS which is refractory to supportive therapies and anticoagulation [10]. The rationale for TIPS in the treatment of HSOS is similar to that of Budd-Chiari syndrome, in which the portosystemic shunt relieves hepatic congestion and increases hepatic artery perfusion and improves hepatic function [11]. The efficacy of TIPS for GS-related HSOS remains controversial [8, 9]
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