Hepatic encephalopathy: Modern views on the treatment of abnormal portosystemic shunt

Shuaijie QIAN; Hao WU

doi:10.3969/j.issn.1001-5256.2021.12.007

Volume 37 Issue 12

Dec. 2021

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2021 > 37(12): 2774-2777

PDF( 1876 KB)

Hepatic encephalopathy: Modern views on the treatment of abnormal portosystemic shunt

DOI: 10.3969/j.issn.1001-5256.2021.12.007

Shuaijie QIAN,
Hao WU^,

Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China

Research funding:

Sichuan Science and Technology Program (22ZDYF0621);

1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH024);

Technological Innovation R & D Project of Chengdu Science and Technology Bureau (2021-YF05-01285-SN)

Received Date: 2021-08-04
Accepted Date: 2021-08-31
Published Date: 2021-12-20

Abstract

Abstract

Hepatic encephalopathy (HE) is a type of serious brain dysfunction caused by acute or chronic liver failure or portosystemic shunt, with the clinical manifestation of neuropsychiatric abnormalities. The incidence rate of HE is 16%-21% in patients with liver cirrhosis. Spontaneous portosystemic shunt (SPSS) is one of the major pathogenesis of HE and is observed in 60%-70% of the patients with liver cirrhosis, and the size, number, and location of SPSS are directly associated with the development of HE. The development and wide application of imaging technology help to achieve a more convenient and accurate diagnosis of SPSS. Although interventional vascular embolization of SPSS has achieved a satisfactory clinical outcome in some cirrhotic patients with HE, high-quality clinical studies are still needed.
- Hepatic Encephalopathy,
- Liver Cirrhosis,
- Spontaneous Portosystemic Shunts,
- Endovascular Procedures

FullText(HTML)

References(31)

References

[1]	VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60(2): 715-735. DOI: 10.1002/hep.27210.
[2]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007. 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.
[3]	TAPPER EB, ZHAO L, NIKIRK S, et al. Incidence and bedside predictors of the first episode of overt hepatic encephalopathy in patients with cirrhosis[J]. Am J Gastroenterol, 2020, 115(12): 2017-2025. DOI: 10.14309/ajg.0000000000000762.
[4]	TAPPER EB, PARIKH ND, SENGUPTA N, et al. A risk score to predict the development of hepatic encephalopathy in a population-based cohort of patients with cirrhosis[J]. Hepatology, 2018, 68(4): 1498-1507. DOI: 10.1002/hep.29628.
[5]	ELSAID MI, RUSTGI VK. Epidemiology of hepatic encephalopathy[J]. Clin Liver Dis, 2020, 24(2): 157-174. DOI: 10.1016/j.cld.2020.01.001.
[6]	WANG Q, LV Y, BAI M, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67(3): 508-516. DOI: 10.1016/j.jhep.2017.05.006.
[7]	BAJAJ JS, O'LEARY JG, TANDON P, et al. Hepatic encephalopathy is associated with mortality in patients with cirrhosis independent of other extrahepatic organ failures[J]. Clin Gastroenterol Hepatol, 2017, 15(4): 565-574. e4. DOI: 10.1016/j.cgh.2016.09.157.
[8]	SHAHEEN AA, NGUYEN HH, CONGLY SE, et al. Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States[J]. Liver Int, 2019, 39(5): 878-884. DOI: 10.1111/liv.14054.
[9]	WIJDICKS EF. Hepatic encephalopathy[J]. N Engl J Med, 2016, 375(17): 1660-1670. DOI: 10.1056/NEJMra1600561.
[10]	HADJIHAMBI A, HARRISON IF, COSTAS-RODRíGUEZ M, et al. Impaired brain glymphatic flow in experimental hepatic encephalopathy[J]. J Hepatol, 2019, 70(1): 40-49. DOI: 10.1016/j.jhep.2018.08.021.
[11]	BOSCH J, GROSZMANN RJ, SHAH VH. Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments[J]. J Hepatol, 2015, 62(1 Suppl): S121-S130. DOI: 10.1016/j.jhep.2015.01.003.
[12]	SIMÓN-TALERO M, ROCCARINA D, MARTÍNEZ J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis[J]. Gastroenterology, 2018, 154(6): 1694-1705. e4. DOI: 10.1053/j.gastro.2018.01.028.
[13]	PRAKTIKNJO M, SIMÓN-TALERO M, RÖMER J, et al. Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis[J]. J Hepatol, 2020, 72(6): 1140-1150. DOI: 10.1016/j.jhep.2019.12.021.
[14]	RATHI S, BROCCO S, FORMENTIN C, et al. Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations[J]. Dig Liver Dis, 2021, 53(11): 1468-1475. DOI: 10.1016/j.dld.2020.11.020.
[15]	LEITE AF, MOTA A Jr, CHAGAS-NETO FA, et al. Acquired portosystemic collaterals: Anatomy and imaging[J]. Radiol Bras, 2016, 49(4): 251-256. DOI: 10.1590/0100-3984.2015.0026.
[16]	SAAD WE, LIPPERT A, SAAD NE, et al. Ectopic varices: Anatomical classification, hemodynamic classification, and hemodynamic-based management[J]. Tech Vasc Interv Radiol, 2013, 16(2): 158-175. DOI: 10.1053/j.tvir.2013.02.004.
[17]	SAAD WE. Portosystemic shunt syndrome and endovascular management of hepatic encephalopathy[J]. Semin Intervent Radiol, 2014, 31(3): 262-265. DOI: 10.1055/s-0034-1382795.
[18]	RIGGIO O, EFRATI C, CATALANO C, et al. High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: A case-control study[J]. Hepatology, 2005, 42(5): 1158-1165. DOI: 10.1002/hep.20905.
[19]	ZARDI EM, UWECHIE V, CACCAVO D, et al. Portosystemic shunts in a large cohort of patients with liver cirrhosis: Detection rate and clinical relevance[J]. J Gastroenterol, 2009, 44(1): 76-83. DOI: 10.1007/s00535-008-2279-1.
[20]	DÖMLAND M, GEBEL M, CASELITZ M, et al. Comparison of portal venous flow in cirrhotic patients with and without paraumbilical vein patency using duplex-sonography[J]. Ultraschall Med, 2000, 21(4): 165-169. DOI: 10.1055/s-2000-6928.
[21]	BANDALI MF, MIRAKHUR A, LEE EW, et al. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy[J]. World J Gastroenterol, 2017, 23(10): 1735-1746. DOI: 10.3748/wjg.v23.i10.1735.
[22]	TASLAKIAN B, FARAJ W, KHALIFE M, et al. Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists[J]. Eur J Radiol, 2015, 84(8): 1525-1539. DOI: 10.1016/j.ejrad.2015.04.021.
[23]	ISHIKAWA Y, YOSHIDA H, MAMADA Y, et al. Surgical disconnection of patent paraumbilical vein in refractory hepatic encephalopathy[J]. J Nippon Med Sch, 2008, 75(3): 152-156. DOI: 10.1272/jnms.75.152.
[24]	GOMEZ GAVARA C, BHANGUI P, SALLOUM C, et al. Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients[J]. Liver Transpl, 2018, 24(4): 505-515. DOI: 10.1002/lt.24999.
[25]	Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019 edition)[J]. Chin J Dig Surg, 2019, 18(12): 1087-1093. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.001. 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(12): 1087-1093. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.001.
[26]	LALEMAN W, SIMON-TALERO M, MALEUX G, et al. Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy[J]. Hepatology, 2013, 57(6): 2448-2457. DOI: 10.1002/hep.26314.
[27]	HE C, LV Y, WANG Z, et al. Association between non-variceal spontaneous portosystemic shunt and outcomes after TIPS in cirrhosis[J]. Dig Liver Dis, 2018, 50(12): 1315-1323. DOI: 10.1016/j.dld.2018.05.022.
[28]	MUKUND A, RAJESH S, ARORA A, et al. Efficacy of balloon-occluded retrograde transvenous obliteration of large spontaneous lienorenal shunt in patients with severe recurrent hepatic encephalopathy with foam sclerotherapy: Initial experience[J]. J Vasc Interv Radiol, 2012, 23(9): 1200-1206. DOI: 10.1016/j.jvir.2012.05.046.
[29]	MUKUND A, CHALAMARLA LK, SINGLA N, et al. Intractable hepatic encephalopathy in cirrhotic patients: Mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration[J]. Eur Radiol, 2020, 30(6): 3462-3472. DOI: 10.1007/s00330-019-06644-4.
[30]	LEE EW, SAAB S, KALDAS F, et al. Coil-assisted retrograde transvenous obliteration (CARTO): An alternative treatment option for refractory hepatic encephalopathy[J]. Am J Gastroenterol, 2018, 113(8): 1187-1196. DOI: 10.1038/s41395-018-0109-5.
[31]	GWON DI, KIM YH, KO GY, et al. Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy: A prospective multicenter study[J]. J Vasc Interv Radiol, 2015, 26(11): 1589-1595. DOI: 10.1016/j.jvir.2015.07.011.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (758) PDF downloads(98)

Hepatic encephalopathy: Modern views on the treatment of abnormal portosystemic shunt

DOI: 10.3969/j.issn.1001-5256.2021.12.007

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Hepatic encephalopathy: Modern views on the treatment of abnormal portosystemic shunt

DOI: 10.3969/j.issn.1001-5256.2021.12.007

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content