Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt.
Ascites
Biliary congestion
Bleeding
Cholestasis
Cirrhosis
Transjugular intrahepatic portosystemic shunt
Journal
World journal of gastroenterology
ISSN: 2219-2840
Titre abrégé: World J Gastroenterol
Pays: United States
ID NLM: 100883448
Informations de publication
Date de publication:
21 Nov 2019
21 Nov 2019
Historique:
received:
31
07
2019
revised:
25
09
2019
accepted:
07
11
2019
entrez:
5
12
2019
pubmed:
5
12
2019
medline:
30
4
2020
Statut:
ppublish
Résumé
Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt (TIPS) (SIC-T), is a rare complication of this technique and only referred by case reports. Thus, we conducted a systematic, retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct compression. To assess prevalence and outcome of SIC-T in a large TIPS-cohort. In this retrospective cohort study, we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August 2013. We analyzed radiologic images for signs of biliary congestion. Cases that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was collected. Descriptive statistics of patient demographics, indications for TIPS and procedural details were registered. Logistic regression analysis was performed to identify predictors for the development of SIC-T. We analyzed 135 cirrhotic patients who underwent TIPS (mean age 55 years, 79% male gender). Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal bleeding. TIPS revision was necessary in 31 patients. We identified 4 cases (2.9%) of SIC-T in direct proximity of the TIPS-stent. Diagnosis was confirmed by CT-scan, MRI or endoscopic retrograde cholangio pancreaticography (ERCP). In two patients TIPS was implanted via the right and in one through the medial hepatic vein. One patient received TIPS-prolongation by multiple revisions. Most patients were asymptomatic but one cholangitic abscess necessitated a transhepatic drain. Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor (OR 21.0) for SIC-T. SIC-T ads to (mostly late) complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic abscesses. Patients, particularly with multiple interventions, should be screened for SIC-T.
Sections du résumé
BACKGROUND
BACKGROUND
Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt (TIPS) (SIC-T), is a rare complication of this technique and only referred by case reports. Thus, we conducted a systematic, retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct compression.
AIM
OBJECTIVE
To assess prevalence and outcome of SIC-T in a large TIPS-cohort.
METHODS
METHODS
In this retrospective cohort study, we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August 2013. We analyzed radiologic images for signs of biliary congestion. Cases that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was collected. Descriptive statistics of patient demographics, indications for TIPS and procedural details were registered. Logistic regression analysis was performed to identify predictors for the development of SIC-T.
RESULTS
RESULTS
We analyzed 135 cirrhotic patients who underwent TIPS (mean age 55 years, 79% male gender). Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal bleeding. TIPS revision was necessary in 31 patients. We identified 4 cases (2.9%) of SIC-T in direct proximity of the TIPS-stent. Diagnosis was confirmed by CT-scan, MRI or endoscopic retrograde cholangio pancreaticography (ERCP). In two patients TIPS was implanted via the right and in one through the medial hepatic vein. One patient received TIPS-prolongation by multiple revisions. Most patients were asymptomatic but one cholangitic abscess necessitated a transhepatic drain. Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor (OR 21.0) for SIC-T.
CONCLUSION
CONCLUSIONS
SIC-T ads to (mostly late) complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic abscesses. Patients, particularly with multiple interventions, should be screened for SIC-T.
Identifiants
pubmed: 31798279
doi: 10.3748/wjg.v25.i43.6430
pmc: PMC6881513
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
6430-6439Informations de copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript. All the authors have no conflict of interest related to the manuscript.
Références
Gastroenterology. 2015 Sep;149(3):660-8.e1
pubmed: 25989386
N Engl J Med. 2000 Jun 8;342(23):1701-7
pubmed: 10841872
Clin Radiol. 2018 Jun;73(6):580-587
pubmed: 29475551
Liver Transpl. 2011 Mar;17(3):344-6
pubmed: 21384518
Hepatology. 2010 Jan;51(1):306
pubmed: 19902484
Transplant Proc. 2004 May;36(4):926-8
pubmed: 15194319
Clin Gastroenterol Hepatol. 2018 Jul;16(7):1153-1162.e7
pubmed: 29378312
Radiographics. 1993 Nov;13(6):1185-210
pubmed: 8290720
Aliment Pharmacol Ther. 2019 Jan;49(1):20-30
pubmed: 30450634
Aliment Pharmacol Ther. 2016 Nov;44(10):1051-1061
pubmed: 27670147
Endoscopy. 2013;45 Suppl 2 UCTN:E47-8
pubmed: 23526512
Liver. 2001 Oct;21(5):361-4
pubmed: 11589774
Ann Intern Med. 1998 Mar 1;128(5):374-7
pubmed: 9490598
Dig Liver Dis. 2017 Feb;49(2):121-137
pubmed: 27884494
N Engl J Med. 1994 Jan 20;330(3):165-71
pubmed: 8264738
Hepatology. 2019 Jan;69(1):282-293
pubmed: 30014519
J Hepatol. 2010 Sep;53(3):397-417
pubmed: 20633946
N Engl J Med. 2010 Jun 24;362(25):2370-9
pubmed: 20573925
J Hepatol. 2013 Nov;59(5):1081-93
pubmed: 23811307
Liver Int. 2007 Aug;27(6):742-7
pubmed: 17617116
Eur J Gastroenterol Hepatol. 2019 May;31(5):626-632
pubmed: 30550458