Intractable hepatic encephalopathy in cirrhotic patients: mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration.
Adult
Aged
Balloon Occlusion
/ methods
Esophageal and Gastric Varices
/ etiology
Female
Hepatic Encephalopathy
/ etiology
Humans
Hypertension, Portal
/ complications
Liver Cirrhosis
/ complications
Male
Middle Aged
Recurrence
Renal Veins
Retrospective Studies
Sclerosing Solutions
/ therapeutic use
Sodium Tetradecyl Sulfate
/ therapeutic use
Splenic Vein
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome
Cirrhosis
Hepatic encephalopathy
Portosystemic shunt
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
27
05
2019
accepted:
18
12
2019
revised:
16
12
2019
pubmed:
13
2
2020
medline:
18
11
2020
entrez:
13
2
2020
Statut:
ppublish
Résumé
To evaluate the efficacy and intermediate-term outcome of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hepatic encephalopathy (HE) secondary to portosystemic shunt (PSS) in cirrhotic patients. Institutional review board (IRB) approval was obtained for this study and hospital records of patients who underwent BRTO, from August 2011 to August 2015, were analyzed. Based on the inclusion and exclusion criteria, 39 patients (age, 54.07 ± 9.1 years (37-67 years); 33 males and 6 females) with cirrhosis and spontaneous PSS were included. Clinical and laboratory parameters and HE grade were evaluated in all patients before and after the procedure. Forty sessions of BRTO were attempted in 39 patients. Follow-up imaging revealed complete obliteration of the treated PSS in all patients with clinical success in 37 patients (94.9%). The 1-, 2-, 3-, 4-, 5-, 6-, and 7-year HE-free survival rates among responders were 91.7%, 91.7%, 88.8%, 85.5%, 80.8%, 80.8%, and 80.8% respectively and overall survival rates were 89.7%, 82.1%, 76.9%, 74.4%, 74.4%, 64.8%, and 64.8% respectively. Logistic regression highlighted Child-Turcotte-Pugh (CTP) score at 6 months as a positive predictive factor of HE recurrence with a cutoff of ≥ 9. Five patients (12.8%) had fever and leukocytosis and 1 (2.6%) patient developed spontaneous bacterial peritonitis after the procedure. BRTO is an effective treatment for refractory HE in cirrhotics secondary to large PSS with a few possible complications. • BRTO is an effective and safe treatment for refractory HE, arising from PSS in cirrhotic patients. • Patients with preserved liver function show better outcome and CTP score is the most important predictor of relapse during follow-up.
Identifiants
pubmed: 32048037
doi: 10.1007/s00330-019-06644-4
pii: 10.1007/s00330-019-06644-4
doi:
Substances chimiques
Sclerosing Solutions
0
Sodium Tetradecyl Sulfate
Q1SUG5KBD6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3462-3472Références
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